Contact Us: Whaleyville Volunteer Fire Department P.O. Box 8037 6235 Whaleyville Blvd. Suffolk, VA 23438 Telephone: 1 (757) 986-3300 Telephone 2: 1 (757) 620-9072 E-Mail: chief@whaleyvillevfd8.org Online Membership Form Last Name   First Name   MI Address  City   State   ZIP   Years at Address Home Phone   E-mail Address Date of Birth   SS# (Optional) Drivers License #   Date Driving Record Received Approved for Driver Training Yes No Employer   Work Phone Employer Address City   State   ZIP EMERGENCY CONTACT Name   Relationship Address  City   State   ZIP Home #   Work #   Mobile # MEDICAL INFORMATION AND IDENTIFYING MARKS Allergies Current Medications Medical Conditions Height   Weight   Eye Color   Hair Color Do you wear contact lenses Yes No   If yes, how long? Other Remarks: Please enter security code 5987
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