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Volunteer Firemen Exposure Form
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= Required Fields
Name of Volunteer Fire Company:
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Bureau File Number:
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Numeric Only
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Home Area (City - Township - Borough):
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County:
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Policy Effective Date:
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mm/dd/yyyy
Your Information
Your Name:
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Your Office Location:
Your Telephone Number:
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xxx-xxx-xxxx
Your Email Address:
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Does the Volunteer Fire Company cited above service the entire population within the boundaries of its home area?
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Yes
No
Does the Volunteer Fire Company cited above provide fire protection outside the boundaries of its home area (Exclude Mutual Aid Arrangements)?
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Yes
No
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