THE MARYLAND STATE FIREMEN'S ASSOCIATION
Annual Statistical Report
for the year ending December 31, 2007

MFIRS/MAIS Number: (6 digit number - County + Station)

Full Legal Name of Company or Department:

Mailing Address:

Physical Address (if different):

City: , State Zip

Phone Number: Fax Number:
Email Address:
Web Site:

All of the Form Fields below should be numbers, please be as accurate as possible.

Response Area Population:

Number of Stations:

PERCENTAGE OF INCOME BY SOURCE:

County: State: Billing:
Fund Raising: Fund Drives: Other:

MEMBERSHIP BY CATEGORY:

Active Volunteers: Life Members: Cadets:
Fire Police: Support/Auxiliary Members:
Retired Members: Inactive Members:
Other Types of Volunteers:
Total Volunteers:
Career/Paid Employees:
Total Members:

MEMBERSHIP BY AGE:

16 - 29: 30 - 39: 40 & Over:

TRAINING:

Fire:
Pre-Basic: Basic/FF-I: Intermediate/FF-II:
Advanced/FO-I & Above: No Fire Training:

Rescue:
Basic: Intermediate/Technician:
Advanced/Specialist: No Rescue Training:

EMS:
CPR: First Responder: EMT-B:
CRT: EMT-P: College:

Haz-Mat:
Awareness: Operations: Technician:
Specialist: WMD/Terrorism: No Haz-Mat Training:

DRILL/TRAINING HOURS:

Fire: Rescue: EMS: Haz-Mat:
Other: Total:

HOURS OF MEMBER ACTIVITY:

Fire/Rescue Calls: EMS Calls: Fire Prevention:
Fund Raising: Administration/Meetings:
Maintenance: Stand-by/Misc:
Total:

CERTIFICATION:

The Undersigned Does Hereby Certify That, To The Best Of His/Her Knowledge,
The Above Information Is True and Correct

Name of Submitting Official:

Title of Submitting Official:

Email Address of Submitting Official:

Telephone Number of Submitting Official:

Any problems or questions should be emailed to Barry Johnson