Mechanicsville Volunteer Rescue Squad, Inc.
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Auxiliary Membership Application

Required   Indicates Required Field
Name (Last, First, Middle): Required
Mailing Address: Required
Date of Birth: Required
Home Telephone:
Business Telephone:
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Next of Kin Name: Required
Next of Kin Phone Number: Required
Next of Kin Address: Required
Location of Residence or Business:
Date of Application: 06/15/2024 1603
Signature of Applicant: Required
Note: You must attend three membership meetings before you are eligible for membership
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Second Meeting:
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Date Voted on:
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Mechanicsville Volunteer Rescue Squad, Inc.
28120 Old Flora Corner Road
P.O. Box 15
Mechanicsville, MD 20659
Emergency Dial 911
Non-Emergency: 301-884-2900
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