RETIRED MEMBER APPLICATION
Retired Black Shield members are retired or former public safety officers and first responders. Membership dues are $25/year and due at the time of acceptance. The Black Shield reviews applications on the 15th of every month.
You will receive notification via email.
First and Last Name
Street Address, City and State
How would YOU like to get involved with The Black Shield?
Youth and Schools
Business / Resident Relations
Diversity on the Force
Name of Former Public Safety Agency.
Please include city.
Send me a copy of my responses.
Page 1 of 1
Never submit passwords through Google Forms.
This form was created inside of The Black Shield.