Print this form and mail to:

High Desert RFPA
PO Box 34
Summer Lake, Oregon 97640

High Desert Rangeland Fire Protection Association Membership Application Form

If you are a current member of the association and the Association responds to a fire on you land, you will not be billed for the associations time and equipment use.

Name: ________________________________________________________

Address:______________________________________________________

City: ________________________State:____________

Zip Code:________________________

Phone Number:_________________________

Would you be willing to be on a “CALL LIST” to respond to fires in your area?

______Yea ______No

Fees are as follows:

Individuals: $50.00

Small landowners <160 acres: $100.00

Large landowners > 160 acres: $200.00

Corporations/Organizations: $200.00

Donations: ________________________

Annual Membership Dues:$______________

I, hereby, request to be accepted into the membership of the High Desert Rangeland Fire Protection Association. I understand that as a member I will abide by the by-laws of the Association. Failure to do so may result in the cancellation of my membership.

Signature: ___________________________________

Date: ___________________________