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. A problem was detected in the following Form. Submitting it could result in errors. Please contact the site administrator. Membership Type On Call/Retained Only Wholetime Only Dual Contract (Wholetime/Retained) On-Call Firefighter In Development Support Staff Associate/Retired Control 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) Start Date Retirement Date Home Address Postcode Tel/Mobile (no spaces) Email Payment Method Deduction from Salary Direct Debit Annual Cheque National Insurance Number FRSA Accidental Injury, Illness and Death Insurance Scheme? Yes No Send