Delaware Valley Preparedness Group

Membership Agreement & Background Check Authorization

Delaware Valley Preparedness Group


Applicant Information

Full Legal Name

Date

November 8, 2026

Date of Birth

Phone Number

Email Address

Chapter

Home Address (Street, City, State, ZIP)

Membership Agreement

By signing below, I agree to abide by the rules, bylaws, and code of conduct of the Delaware Valley Preparedness Group (DVPG). I understand that membership is a privilege and may be revoked at any time for conduct unbecoming of a member, violation of group policies, or any other reason deemed appropriate by the DVPG leadership.

I agree to treat all fellow members with respect, to keep member contact information and group operational details confidential, and to participate in good faith in group activities and preparedness efforts.

I understand that DVPG is a volunteer community organization and that membership does not create an employment, agency, or fiduciary relationship of any kind.

I confirm that I am 18 years of age or older and that all information provided in my application is true and accurate to the best of my knowledge.

Background Check Authorization

I hereby authorize Delaware Valley Preparedness Group and its designated agents to conduct a background check as part of the membership review process. This may include, but is not limited to, a review of criminal history records, sex offender registries, and other publicly available records.

I understand that the results of this background check will be kept strictly confidential and used solely for the purpose of evaluating my membership application. I acknowledge that a background check finding may result in denial or revocation of membership at the sole discretion of DVPG leadership.

I release Delaware Valley Preparedness Group, its officers, chapter leads, and volunteers from any liability arising from the conduct of this background check or any membership decision made in connection with it.

Social Security Number (last 4 digits)

Driver's License / State ID Number

State of Issue

ID Expiration Date

Acknowledgements

Signatures

Applicant Signature

Date

Printed Name

For Office Use Only

Reviewed By

Review Date

Background Check Completed

Result

Membership Decision

☐ Approved ☐ Declined ☐ Pending

Decision Date

Notes

Authorized Officer Signature

Date

Delaware Valley Preparedness Group · delvalpg.com · This document is confidential and for internal use only.

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