Applicant Information
Name:
Organization:
Mailing Address:
Title:	Email:
Phone:	Fax:
For Office Use Only
New Member: ☐	Renewal: ☐
Valid for Year of: Click here to select year	Payment Received: ☐	Click here to enter a date.
Please complete the top portion of this for. Return this form enclosing a cheque in the amount of $200 payable to:
OMFPOA c/o Gwen Lewis CFEI Assistant Division Chief Ottawa Fire Services 101 Centrepointe Drive, 3rd Floor Ottawa, ON K2G 5K7