FPA Membership Application - Hartbeeshoek Fire Watch

This online form mirrors the official MFPA application form. Your submission will be forwarded to the MFPA for processing. Membership is subject to approval and annual subscription fee payment. View our Privacy Policy.

1. Applicant Details

Full Name (Title, Initials and/or First Names, and Surname)

Email Address

Name of Business (if applicable)

Farm Name, Common Name, Number, or Traditional Authority

Title Deed Number

Physical Location

GPS Latitude

GPS Longitude

Area (Hectares)

Vegetation Type

Special Risks (e.g. bulk fuel storage)

Postal Address

Cluster Name

2. Contact Persons (in priority of emergency response)

List the people responsible for the property. The primary contact is required.

Primary Contact

Contact Person 1 - Name

Position

Cell Number

Phone / Landline

Radio Call-sign / Frequency

Second Contact (optional)

Name

Position

Cell

3. Firefighting Capacity

Personnel Details (trained levels, untrained count)

List your trained and untrained firefighting personnel with training levels.

Equipment Available (water tankers, bakkie-sakkies, knapsack sprayers, fire-beaters, rake-hoes, etc.)

List all firefighting equipment available on your property. See equipment requirements for guidelines.

Water Supply Point Details and Type

Water Supply GPS Latitude

Water Supply GPS Longitude

4. Declarations

I have read and understood the National Veld and Forest Fire Act No. 101 of 1998

I have read and understood the constitution of the Madibeng Fire Protection Association

I have read and understood the Rules of the Madibeng Fire Protection Association

I agree to abide by the constitution and rules of the Madibeng Fire Protection Association

POPIA Notice: By submitting this form, your personal information will be collected and processed for the purpose of MFPA membership application processing. Your data will be forwarded to the MFPA and stored securely. You may request access, correction, or deletion of your data at any time. Read full Privacy Policy.

I consent to the collection and processing of my personal information as described in the Privacy Policy

5. Signature

Digital Signature (type your full name)

Date

Community Verification

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Community Password

Your application will be forwarded to the MFPA for review. Membership is valid subject to annual subscription fee payment.

This form is based on the official MFPA Application Form. Contact MFPA directly at Madibengfpa@gmail.com or Chair Mr. Mosue SS: 081 352 1269.

MFPA Membership Application

1. Applicant Details

2. Contact Persons (in priority of emergency response)

Primary Contact

Second Contact (optional)

3. Firefighting Capacity

4. Declarations

5. Signature

Community Verification