Page 1 of 4 Membership Application Please complete all required fields! The Santa Clara County FireSafe Council (SCFSC) is a 501(c)(3) public benefit (non-profit) corporation. Our mission is “Mobilizing the people of Santa Clara County to protect their homes, communities and environment from wildfires.” Our primary programs and projects are: • Community Outreach and Education Programs including distributing wildfire prevention literature and other materials at community events and meetings. These programs also include programs for schools with Wildland Interface attendance areas and programs for seniors and other groups. • Hazardous Fuel Assessment and Strategy Projects where our participating organizations and other stakeholders develop Community Wildfire Protection Plans. These plans identify fire prone areas in Santa Clara County and appropriate treatments to reduce the risk of wildfires. • Hazardous Fuel Reduction Projects which typically involve clearing and chipping operations to reduce hazardous fuel accumulations. Our participants include the major fire agencies in Santa Clara County, many volunteer fire organizations, local utility companies, parks and open space organizations, city and county government representatives, neighborhood associations, and concerned individuals. Our programs are funded by federal grants and by local grants and donations from fire agencies, organizations, companies and individuals. Required fields are marked with an *. How did you hear about the Santa Clara County FireSafe Council?* Our Web SiteOther Web SiteFriend or NeighborNewspaperOther Invalid Input If Other, please describe Invalid Input Contact Information Your name* Invalid Input Phone Invalid Input Email* Invalid Input Preferred Contact PhoneEmail Invalid Input Address (line 1)* Invalid Input Address (line 2) Invalid Input City* Invalid Input State* AlabamaAlaskaArizonaArkansasCalifornia ColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Invalid Input Zip Code* Invalid Input If you are affiliated with a fire department, government agency, company or organization (e.g., Homeowners or Neighborhood Organization), please complete the following organization questions: Your organization Invalid Input Your Title Invalid Input Organization Address (line 1) Invalid Input Organization Address (line 2) Invalid Input Organization City Invalid Input Organization State Invalid Input Organization Zip Code Invalid Input Information Request Please indicate if you would like: Information on how to create Defensible Space around your homeInformation on Santa Clara County FireSafe Council meetingsOther Invalid Input If Other, please describe: Invalid Input Participation in the Santa Clara County FireSafe Council Please check one or more ways in which you would be willing to participate in and assist SCFSC. Add any other activities that might assist SCFSC. * Participate in Hazardous Fuel Reduction projectsHelp organize Hazardous Fuel Reduction projectsPrepare grant applications for Hazardous Fuel Reduction projectsDistribute literature and other materials and answer questions at community eventsHelp Smokey Bear educate children about wildfire prevention in schools and librariesMake short presentations on SCFSC and Defensible Space at local community meetingsHelp to organize community events and meetingsWrite articles for the newsletter or prepare other materials for the websiteHelp to manage and administer the SCFSC Web site (www.SCCFireSafe.org)Participate in developing Community Wildfire Protection PlansServe as an SCFSC Officer or DirectorOther Please check one of the boxes to show how you would be willing to participate in and assist SCFSC. If other, please describe: Invalid Input Please enter any other comments or suggestions: Invalid Input