BY-LAWS
Here is the most recent copy of the By-laws for PHVFD:
Article I
OFFICE for PHVFD
Section 1. Principal Office. The principal of PHVFD is on HWY 22, (Comer Road), Comer, Georgia, 30629
Section 2. Other Offices. The mailing address of PHVFD is P.O. Box 192 Comer, Georgia, 30629
Article II
MEETINGS AND MEMBERS
Section 1. Regular Meetings. Regular meeting will be held on the 2nd Monday of each month at the Principal Office and shall convene at 19:00 hours, (7:00 pm), except as altered by Holidays or other pressing functions approved by the Chief.
Section 2. Training Meeting. Training meetings will be held on the 4th Monday of each month at the Principal Office and shall convene at 19:00 hours, (7:00 pm), except as altered by Holidays or other pressing functions approved by the Chief.
Section 3. Place of Holding Meetings. All meetings of the members shall be held at the principal office for PHVFD or elsewhere as designated by the officers.
Section 4. Notice of Meeting. Each of the meetings shall be paged out one hour prior to the start of each meeting.
Section 5. Voting. At all meetings of the members of PHVFD, every member entitled to vote thereat shall have one (1) vote. Such vote may be either in person or by proxy appointed by an instrument in writing subscribed by such member or his/her duly authorized attorney, bearing a date not more than 3 months prior to said meeting, unless said instrument provides for a longer period. Such proxy shall be dated, but need not be sealed, witnessed or acknowledged. All elections shall be had and all questions shall be decided by a majority of the votes cast at a duly constituted meeting, except as otherwise provided by law, in the By-Laws. Any member who has failed to attend five of the previous twelve meetings shall not be eligible to vote.
If the Chief or Officer of the meeting shall so determine, a vote by ballot may be taken upon any election or matter and the vote shall be so taken upon the request of ten percent, (10%), or more of all the members entitled to vote on such election or matter. In either of such events, the proxies and ballots shall be received and be taken in charge and all questions touching the qualification of voters and the validity of proxies and the acceptance or rejection of votes, shall be decided by the tellers. The Chief or Officer of said meeting shall appoint tellers.
Section 6.) Identity of Members. The members of PHVFD shall be composed of those members who have been voted on by the majority of PHVFD and shall retain their status as members so long as they satisfy all training and other such written requirements and Standards that are in the Oglethorpe County Standard Operating Procedures, (OCSOG).
Section 7. Voting of members. The new prospect members shall be voted on by the majority of PHVFD.
Section 8. Prospect Members. New prospect members shall live inside the PHVFD district. Any new member that lives outside the district shall be voted on in an individual basis. (All existing members shall be excluded from this section). The prospect member shall receive and fill out an application to become a prospect member. Then return it to a station officer that will give it to the station Chief of Asst. Chief. Prospect members will be required to attend three, (3), regular meetings, (Article II, Section 1), and be required to attend two, (2), training meetings, (Article II, Section 2). On the third, (3rd) regular meeting the new prospect for PHVFD shall be voted on by a majority of members at this meeting.
Section 9. Categories of Members. Member shall consist of one of the following categories, all of which are voted on by PHVFD active members, (Article II, Section 9).
Junior Fire Fighter= A junior FF will be 17 years of age or younger but not less than 12 years of age who is in good standing with PHVFD and is a non-voting member.
(Active) An active member will be any member 18 years of age or older who is in good standing with PHVFD and is a voting member.
(Reserve) A reserve member will be any member 18 years of age or older who is in good standing with PHVFD that is currently non-active and is a non-voting member.
(Life) A life member is any of the original founding members of PHVFD and is a non-voting member.
Section 10. Meeting Requirements. All members are asked to be present for at least six, (6) of the twelve, (12), regular and six, (6) of the twelve, (12), training meetings. If the member is not able to attend a meeting or meetings, contact an officer or another member to let them know the member will be late or not going to be able to attend that meeting or meetings. If the member misses more than his/her six, (6), regular or six, (6), training meetings that member will face disciplinary actions. Each missed meeting will be reviewed and discussed with that member on an individual basis.
Article III
Line Officers
Section 1. Election and Tenure. The Line Officers of PHVFD shall be as follows;
Chief, Assistant Chief, Captain, Lieutenant, Secretary, Treasurer, and Training Officer. These By-Laws do not require each rank below Assistant Chief be filled. The Line Officers shall be voted on by the active members, (Article II, Section 9), and will serve a one, (1) year term. Line Officers take their position on the 1st day of January and relinquish their position on the 31st day of December of the same year.
Section 2. Qualifications for Line Officers. The following is the description of qualifications of each Line Officer.
Chief:
Must be a member in good standings with PHVFD
Must live within PHVFD fire district
Must be Twenty-One, (21), years old
Must have three, (3) years of exp. as a line officer with PHVFD
Must meet the requirements of OCSOG
Must have one, (1) year exp. As Assistant Chief
Must be a qualified Driver-Operator of all PHVFD apparatus
Assistant Chief:
Must be a member in good standings with PHVFD
Must live within PHVFD fire district
Must be Twenty-One, (21), years old
Must have two, (2) years of exp. as a line officer with PHVFD
Must meet the requirements of OCSOG
Must be a qualified Driver-Operator of all PHVFD apparatus
Captain:
Must be a member in good standings with PHVFD
Must be Twenty-One, (21), years old
Must have three, (3) years of exp. as a Fire Fighter
Must meet the requirements of OCSOG
Must be a qualified Driver-Operator of all PHVFD apparatus
Lieutenant:
Must be a member in good standings with PHVFD
Must be Eighteen, (18), years old
Must have one, (1) years of exp. as a Fire Fighter
Must meet the requirements of OCSOG
Must be a qualified Driver-Operator of all PHVFD apparatus
Training Officer:
Must be a member in good standings with PHVFD
Must be Twenty-One, (21), years old
Must meet the requirements of OCSOG
Must be a qualified Driver-Operator of all PHVFD apparatus
Article IV
Personal Protective Equipment (PPE)
Section 1. Turnout Gear. Each active member, (Article II, Section 9), of PHVFD will be issued a set of turnout gear which will include:
Helmet
Coat
Pants
Suspenders
Hood
Gloves
Boots
Gear Bag
SCBA Mask
SCBA Mask bag
Other items included with Gear:
Radio / Pager
Keys for locks on the building
PASS device
Each member will be responsible for the up keep and reports of any problems with their gear. Member may be requested to show their gear at anytime for inspection by PHVFD.
Notify an Officer immediately when damage has occurred to the any of the gear.
Section 2. Rules for turnout gear use. PHVFD turnout gear will be used for calls with PHVFD “ONLY”! (This includes First Responder Calls). The turnout gear is only allowed to be used by PHVFD members responding to PHVFD calls and training. If any member is caught using PHVFD turnout gear in any other district without PHVFD being paged out for that call, will be subject to disciplinary actions, ( Article VII, section 1-A). If the gear is damaged in any way during a PHVFD call, notify an Officer as soon as possible. If the damage to the gear is not related to PHVFD calls then the member will be responsible for the cost of repairing or replacing the damaged gear and subject to disciplinary actions, ( Article VII, section 1-A).
Section 3. Checking out turnout gear. Each member will be required to sign paperwork that will have the description, serial numbers and sizes of said turnout gear. If the member losses or damages the gear in any way not related to a PHVFD call, the member is responsible for the repairs or replacement of said gear and may be subject to disciplinary actions, (Article VII, section 1-A).
Section 4. Helmet Colors. Member will be wearing helmets according to OCSOG
Chief- White; Assistant Chief- White; Captain- Red, Lieutenant- Red, Firefighters- Black
(If you are not an officer you should be wearing a black helmet.)
Article V
Membership to other Departments
Section 1. Membership to other Departments. PHVFD does not frown upon members being involved with other departments in the county. The members that are members of other departments will not use PHVFD turnout gear at the other departments calls, (PHVFD can not afford to replace any gear that is damaged or destroyed while responding to other departments calls).
Section 2. Members attitude at other Departments Scenes. Members of PHVFD that are members of other departments that both departments respond to a call and the call is in PHVFD fire district, The member of PHVFD is responding as PHVFD even if that member is an officer with the other department. All members’ responsibility is with PHVFD when PHVFD is paged out with in their fire district. In the event that PHVFD is paged out as back-up to the department that the member is with the member’s responsibility is with the other department at this call.
In the event that there are problems on a scene do not, I repeat, do not get into a confrontation regarding the issue on the fire scene. Notify your Officer in charge with PHVFD and let them handle the problem. We as a department are to conduct ourselves accordingly, always professional, courteous, and respectful on any and all scenes. If a member of PHVFD is involved in any type of confrontation, (Physical or Verbal), disciplinary actions will be taken, (Article VII, section 1-A).
Article VI
Training
Section 1. Training. Member will be required to complete a basic 101 fire fighter class within 12-18 months of becoming a member of PHVFD. Members that are active, (Article II, Section 9), with PHVFD will be asked to attend monthly training meetings, (Article II sections 2). There will be 12 training meetings per year with the possibility of more on the week-ends. The Training Officer, (TO), will be voted on by the active members of PHVFD.
Section 2. Training Materials. Members will be required to bring their turnout gear to every training meeting in case it is needed in that days training.
Article VII
Standards of Conduct and Discipline
Section 1. All members of PHVFD are expected to conduct themselves at all times in such a manner as will convey a positive image of PHVFD and will in no way impact or reflect adversely on PHVFD.
Whenever a member fails to follow an appropriate standard of conduct, measures must be taken to correct this situation and to prevent further occurrences. Minor offences depend in part upon the circumstances and it is impossible to list all minor offences. The degree of discipline will depend upon the seriousness of the offense and the circumstances under which the offence occurred. In addition, certain major offences warrant immediate suspension or discharge from PHVFD.
THE FOLLOWING IS A STATEMENT OF GENERAL GUIDELINES CONCERNING MEMBERS DISCIPLINE. THE PROCEDURES OUTLINED MAY BE FOLLOWED AT THE DESCRETION OF PLEASANT HILL VOLUNTEER FIRE DEPARMENT DEPENDING ON THE CIRCUMSTANCES AND IN NO WAY LIMITS PLEASANT HILL VOLUNTEER FIRE DEPARTMENT TO TERMINATE A MEMBER FOR CAUSE OR NO CAUSE.
Section 2. Description of disciplinary actions. The following is a breakdown of how discipline will be conducted:
A. Minor Offenses. The procedure for the handling of minor offences is as follows:
1) Written Warning- With or without oral counseling by the immediate supervising officer, will be given to member for the first offence. The written warning will be placed into the members personnel file.
2) A written reprimand will be given to a member for each subsequent minor offence in violation of any PHVFD rules, policy or practice for which he /she had already received a warning. A corrective interview will also be given and the written record of the interview and reprimand will be placed into the members personnel file.
3) Following receipt of a written reprimand and corrective interview, the next offense may result in suspension or discharge from PHVFD at the sole discretion of the elected officers.
B. Major Offenses. Proper cause for immediate suspension or discharge, shall include, but not limited to the following:
1) Possession of illegal drugs on the premises of PHVFD.
2) Carrying any weapon onto PHVFD property or into the department.
3) Chronic or habitual absenteeism or lateness
4) Committing any act of sexual harassment
5) Contributing to unsanitary condition
6) Dishonesty or misrepresenting anything to PHVFD or to the members of PHVFD
7) Failure or refusal to carry out any orders or instructions
8) Failure to fulfill the responsibilities of a job to an extent that might or does cause injury to a person or cause damage to PHVFD property or property of others.
9) Falsification of information requested for PHVFD records
10) Disorderly, or immoral conduct while in PHVFD vehicles or on the premises
11) Obtain Membership on the basis of false or misleading statements.
12) Reckless or negligent behavior that may result in damage to PHVFD property, the property of others, or other persons.
13) Threatened or actual physical violence or profane or abusive language.
14) Unauthorized use of PHVFD vehicles.
15) Unauthorized use of, removal of, theft or intentional damage to property of PHVFD, a member, or third party.
16) Unsatisfactory work performance.
17) Violation of an established safety rule.
18) Arrest or conviction of a member for an alcohol or drug related traffic offense.
Article VIII
BY-LAWS ADDITIONS
Section 1. The officers or members can ask to amend the bylaws at any time but the change will be voted on upon the Members of PHVFD.
I, _______________________________________________, have read and understand
the By-Laws of Pleasant Hill Volunteer Fire Department. I will follow these By-Laws to
the best of my ability in serving the Community that PHVFD protects.
__________________________________________
Member (Print Name)
__________________________________________ _____ / _______ / _______
Member Signature Date
__________________________________________
Witness (Print Name)
__________________________________________ _____ / _______ / _______
Witness Signature Date
Article I
OFFICE for PHVFD
Section 1. Principal Office. The principal of PHVFD is on HWY 22, (Comer Road), Comer, Georgia, 30629
Section 2. Other Offices. The mailing address of PHVFD is P.O. Box 192 Comer, Georgia, 30629
Article II
MEETINGS AND MEMBERS
Section 1. Regular Meetings. Regular meeting will be held on the 2nd Monday of each month at the Principal Office and shall convene at 19:00 hours, (7:00 pm), except as altered by Holidays or other pressing functions approved by the Chief.
Section 2. Training Meeting. Training meetings will be held on the 4th Monday of each month at the Principal Office and shall convene at 19:00 hours, (7:00 pm), except as altered by Holidays or other pressing functions approved by the Chief.
Section 3. Place of Holding Meetings. All meetings of the members shall be held at the principal office for PHVFD or elsewhere as designated by the officers.
Section 4. Notice of Meeting. Each of the meetings shall be paged out one hour prior to the start of each meeting.
Section 5. Voting. At all meetings of the members of PHVFD, every member entitled to vote thereat shall have one (1) vote. Such vote may be either in person or by proxy appointed by an instrument in writing subscribed by such member or his/her duly authorized attorney, bearing a date not more than 3 months prior to said meeting, unless said instrument provides for a longer period. Such proxy shall be dated, but need not be sealed, witnessed or acknowledged. All elections shall be had and all questions shall be decided by a majority of the votes cast at a duly constituted meeting, except as otherwise provided by law, in the By-Laws. Any member who has failed to attend five of the previous twelve meetings shall not be eligible to vote.
If the Chief or Officer of the meeting shall so determine, a vote by ballot may be taken upon any election or matter and the vote shall be so taken upon the request of ten percent, (10%), or more of all the members entitled to vote on such election or matter. In either of such events, the proxies and ballots shall be received and be taken in charge and all questions touching the qualification of voters and the validity of proxies and the acceptance or rejection of votes, shall be decided by the tellers. The Chief or Officer of said meeting shall appoint tellers.
Section 6.) Identity of Members. The members of PHVFD shall be composed of those members who have been voted on by the majority of PHVFD and shall retain their status as members so long as they satisfy all training and other such written requirements and Standards that are in the Oglethorpe County Standard Operating Procedures, (OCSOG).
Section 7. Voting of members. The new prospect members shall be voted on by the majority of PHVFD.
Section 8. Prospect Members. New prospect members shall live inside the PHVFD district. Any new member that lives outside the district shall be voted on in an individual basis. (All existing members shall be excluded from this section). The prospect member shall receive and fill out an application to become a prospect member. Then return it to a station officer that will give it to the station Chief of Asst. Chief. Prospect members will be required to attend three, (3), regular meetings, (Article II, Section 1), and be required to attend two, (2), training meetings, (Article II, Section 2). On the third, (3rd) regular meeting the new prospect for PHVFD shall be voted on by a majority of members at this meeting.
Section 9. Categories of Members. Member shall consist of one of the following categories, all of which are voted on by PHVFD active members, (Article II, Section 9).
Junior Fire Fighter= A junior FF will be 17 years of age or younger but not less than 12 years of age who is in good standing with PHVFD and is a non-voting member.
(Active) An active member will be any member 18 years of age or older who is in good standing with PHVFD and is a voting member.
(Reserve) A reserve member will be any member 18 years of age or older who is in good standing with PHVFD that is currently non-active and is a non-voting member.
(Life) A life member is any of the original founding members of PHVFD and is a non-voting member.
Section 10. Meeting Requirements. All members are asked to be present for at least six, (6) of the twelve, (12), regular and six, (6) of the twelve, (12), training meetings. If the member is not able to attend a meeting or meetings, contact an officer or another member to let them know the member will be late or not going to be able to attend that meeting or meetings. If the member misses more than his/her six, (6), regular or six, (6), training meetings that member will face disciplinary actions. Each missed meeting will be reviewed and discussed with that member on an individual basis.
Article III
Line Officers
Section 1. Election and Tenure. The Line Officers of PHVFD shall be as follows;
Chief, Assistant Chief, Captain, Lieutenant, Secretary, Treasurer, and Training Officer. These By-Laws do not require each rank below Assistant Chief be filled. The Line Officers shall be voted on by the active members, (Article II, Section 9), and will serve a one, (1) year term. Line Officers take their position on the 1st day of January and relinquish their position on the 31st day of December of the same year.
Section 2. Qualifications for Line Officers. The following is the description of qualifications of each Line Officer.
Chief:
Must be a member in good standings with PHVFD
Must live within PHVFD fire district
Must be Twenty-One, (21), years old
Must have three, (3) years of exp. as a line officer with PHVFD
Must meet the requirements of OCSOG
Must have one, (1) year exp. As Assistant Chief
Must be a qualified Driver-Operator of all PHVFD apparatus
Assistant Chief:
Must be a member in good standings with PHVFD
Must live within PHVFD fire district
Must be Twenty-One, (21), years old
Must have two, (2) years of exp. as a line officer with PHVFD
Must meet the requirements of OCSOG
Must be a qualified Driver-Operator of all PHVFD apparatus
Captain:
Must be a member in good standings with PHVFD
Must be Twenty-One, (21), years old
Must have three, (3) years of exp. as a Fire Fighter
Must meet the requirements of OCSOG
Must be a qualified Driver-Operator of all PHVFD apparatus
Lieutenant:
Must be a member in good standings with PHVFD
Must be Eighteen, (18), years old
Must have one, (1) years of exp. as a Fire Fighter
Must meet the requirements of OCSOG
Must be a qualified Driver-Operator of all PHVFD apparatus
Training Officer:
Must be a member in good standings with PHVFD
Must be Twenty-One, (21), years old
Must meet the requirements of OCSOG
Must be a qualified Driver-Operator of all PHVFD apparatus
Article IV
Personal Protective Equipment (PPE)
Section 1. Turnout Gear. Each active member, (Article II, Section 9), of PHVFD will be issued a set of turnout gear which will include:
Helmet
Coat
Pants
Suspenders
Hood
Gloves
Boots
Gear Bag
SCBA Mask
SCBA Mask bag
Other items included with Gear:
Radio / Pager
Keys for locks on the building
PASS device
Each member will be responsible for the up keep and reports of any problems with their gear. Member may be requested to show their gear at anytime for inspection by PHVFD.
Notify an Officer immediately when damage has occurred to the any of the gear.
Section 2. Rules for turnout gear use. PHVFD turnout gear will be used for calls with PHVFD “ONLY”! (This includes First Responder Calls). The turnout gear is only allowed to be used by PHVFD members responding to PHVFD calls and training. If any member is caught using PHVFD turnout gear in any other district without PHVFD being paged out for that call, will be subject to disciplinary actions, ( Article VII, section 1-A). If the gear is damaged in any way during a PHVFD call, notify an Officer as soon as possible. If the damage to the gear is not related to PHVFD calls then the member will be responsible for the cost of repairing or replacing the damaged gear and subject to disciplinary actions, ( Article VII, section 1-A).
Section 3. Checking out turnout gear. Each member will be required to sign paperwork that will have the description, serial numbers and sizes of said turnout gear. If the member losses or damages the gear in any way not related to a PHVFD call, the member is responsible for the repairs or replacement of said gear and may be subject to disciplinary actions, (Article VII, section 1-A).
Section 4. Helmet Colors. Member will be wearing helmets according to OCSOG
Chief- White; Assistant Chief- White; Captain- Red, Lieutenant- Red, Firefighters- Black
(If you are not an officer you should be wearing a black helmet.)
Article V
Membership to other Departments
Section 1. Membership to other Departments. PHVFD does not frown upon members being involved with other departments in the county. The members that are members of other departments will not use PHVFD turnout gear at the other departments calls, (PHVFD can not afford to replace any gear that is damaged or destroyed while responding to other departments calls).
Section 2. Members attitude at other Departments Scenes. Members of PHVFD that are members of other departments that both departments respond to a call and the call is in PHVFD fire district, The member of PHVFD is responding as PHVFD even if that member is an officer with the other department. All members’ responsibility is with PHVFD when PHVFD is paged out with in their fire district. In the event that PHVFD is paged out as back-up to the department that the member is with the member’s responsibility is with the other department at this call.
In the event that there are problems on a scene do not, I repeat, do not get into a confrontation regarding the issue on the fire scene. Notify your Officer in charge with PHVFD and let them handle the problem. We as a department are to conduct ourselves accordingly, always professional, courteous, and respectful on any and all scenes. If a member of PHVFD is involved in any type of confrontation, (Physical or Verbal), disciplinary actions will be taken, (Article VII, section 1-A).
Article VI
Training
Section 1. Training. Member will be required to complete a basic 101 fire fighter class within 12-18 months of becoming a member of PHVFD. Members that are active, (Article II, Section 9), with PHVFD will be asked to attend monthly training meetings, (Article II sections 2). There will be 12 training meetings per year with the possibility of more on the week-ends. The Training Officer, (TO), will be voted on by the active members of PHVFD.
Section 2. Training Materials. Members will be required to bring their turnout gear to every training meeting in case it is needed in that days training.
Article VII
Standards of Conduct and Discipline
Section 1. All members of PHVFD are expected to conduct themselves at all times in such a manner as will convey a positive image of PHVFD and will in no way impact or reflect adversely on PHVFD.
Whenever a member fails to follow an appropriate standard of conduct, measures must be taken to correct this situation and to prevent further occurrences. Minor offences depend in part upon the circumstances and it is impossible to list all minor offences. The degree of discipline will depend upon the seriousness of the offense and the circumstances under which the offence occurred. In addition, certain major offences warrant immediate suspension or discharge from PHVFD.
THE FOLLOWING IS A STATEMENT OF GENERAL GUIDELINES CONCERNING MEMBERS DISCIPLINE. THE PROCEDURES OUTLINED MAY BE FOLLOWED AT THE DESCRETION OF PLEASANT HILL VOLUNTEER FIRE DEPARMENT DEPENDING ON THE CIRCUMSTANCES AND IN NO WAY LIMITS PLEASANT HILL VOLUNTEER FIRE DEPARTMENT TO TERMINATE A MEMBER FOR CAUSE OR NO CAUSE.
Section 2. Description of disciplinary actions. The following is a breakdown of how discipline will be conducted:
A. Minor Offenses. The procedure for the handling of minor offences is as follows:
1) Written Warning- With or without oral counseling by the immediate supervising officer, will be given to member for the first offence. The written warning will be placed into the members personnel file.
2) A written reprimand will be given to a member for each subsequent minor offence in violation of any PHVFD rules, policy or practice for which he /she had already received a warning. A corrective interview will also be given and the written record of the interview and reprimand will be placed into the members personnel file.
3) Following receipt of a written reprimand and corrective interview, the next offense may result in suspension or discharge from PHVFD at the sole discretion of the elected officers.
B. Major Offenses. Proper cause for immediate suspension or discharge, shall include, but not limited to the following:
1) Possession of illegal drugs on the premises of PHVFD.
2) Carrying any weapon onto PHVFD property or into the department.
3) Chronic or habitual absenteeism or lateness
4) Committing any act of sexual harassment
5) Contributing to unsanitary condition
6) Dishonesty or misrepresenting anything to PHVFD or to the members of PHVFD
7) Failure or refusal to carry out any orders or instructions
8) Failure to fulfill the responsibilities of a job to an extent that might or does cause injury to a person or cause damage to PHVFD property or property of others.
9) Falsification of information requested for PHVFD records
10) Disorderly, or immoral conduct while in PHVFD vehicles or on the premises
11) Obtain Membership on the basis of false or misleading statements.
12) Reckless or negligent behavior that may result in damage to PHVFD property, the property of others, or other persons.
13) Threatened or actual physical violence or profane or abusive language.
14) Unauthorized use of PHVFD vehicles.
15) Unauthorized use of, removal of, theft or intentional damage to property of PHVFD, a member, or third party.
16) Unsatisfactory work performance.
17) Violation of an established safety rule.
18) Arrest or conviction of a member for an alcohol or drug related traffic offense.
Article VIII
BY-LAWS ADDITIONS
Section 1. The officers or members can ask to amend the bylaws at any time but the change will be voted on upon the Members of PHVFD.
I, _______________________________________________, have read and understand
the By-Laws of Pleasant Hill Volunteer Fire Department. I will follow these By-Laws to
the best of my ability in serving the Community that PHVFD protects.
__________________________________________
Member (Print Name)
__________________________________________ _____ / _______ / _______
Member Signature Date
__________________________________________
Witness (Print Name)
__________________________________________ _____ / _______ / _______
Witness Signature Date