Join Now Use this form to request FRSA Membership, you will be contacted by FRSA Head Office to confirm details.Alternatively you can download an application form and return to us via FREEPOST. Title Mr Mrs Miss Ms Other Full Name Date of Birth Rank/Role Fire and Rescue Service Avon Bedfordshire Buckinghamshire Cambridgeshire Cheshire Cleveland Cornwall Cumbria Derbyshire Devon & Somerset Dorset & Wiltshire Durham East Sussex Essex Gloucestershire Greater Manchester Guernsey Hampshire Hereford and Worcester Hertfordshire Humberside Isle of Man Isle of Wight Jersey Kent Lancashire Leicestershire Lincolnshire London Merseyside Mid and West Wales Norfolk North Wales North Yorkshire Northern Ireland Northamptonshire Northumberland Nottinghamshire Oxfordshire Royal Berkshire Scottish Shropshire South Wales South Yorkshire Staffordshire Suffolk Surrey Tyne and Wear Warwickshire West Midlands West Sussex West Yorkshire Station Fire Service Start Start Date (if known) Home Address Postcode Tel/Mobile (no spaces) Email Payment Method Deduction from Salary Direct Debit Annual Cheque Membership Type On Call/Retained Only Wholetime Only Dual Contract (Wholetime/Retained) On-Call Firefighter In Development Support Staff Control FRSA Accidental Injury, Illness and Death Insurance Scheme? Yes No National Insurance Number Send