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MEMBERSHIP APPLICATION


First Name: *
Last Name: *
Email: *
Address: *
City: *
State: *
Zip: *
Contact Phone Number: *
DOB: *
Employer: *
Date Hired: *
Rank: *
I, *
certify that I meet the membership requirements for the Fraternal Order of Police as set forth in their national and state Constitution and By-laws. I understand that providing any false information will be grounds for expulsion from the Fraternal Order of Police Lodge.
Last 4 SSN: *
Date: *
Signature: *

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Attach Financial Allotment Confirmation Page Here: *

THIS SECTION IS TO BE COMPLETED BY LOCAL LODGE OFFICERS

I,                                            , Secretary of FOP Lodge           , hereby state that to the best of my knowledge, that the above person is entitled to become a member of the Fraternal Order of Police, as stated in the State Lodge Constitution and By-laws.

                                                
Signature             


I,                                            , President of FOP Lodge           , hereby state that to the best of my knowledge, that the above person is entitled to become a member of the Fraternal Order of Police, as stated in the State Lodge Constitution and By-laws.

                                                
Signature             


Attention Lodge Secretaries: Upon acceptance of members into your lodges, you are required to submit this form to the State Lodge along with your Losses and Gains in Membership form. Members listed on the Losses and Gains form will not be accepted unless accompanied by this form.

Date received in State Lodge:                                  


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National ICE Officers Association
1540 SW 8th Street #1110
Boynton Beach, FL 33426

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