FOP 23 Annual Dues Form
Please complete the form below. By completing this form you agree to the following: 

I, the undersigned, a full–time, regularly employed officer, retired law enforcement officer, or reserve officer do hereby make application for active
membership in Lodge Number 23. 

If my membership should be revoked or discontinued for any cause, I do hereby agree to return to the lodge my membership card and any other material bearing the FOP insignia, such as auto emblem, lapel pin, etc.
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Email *
Name *
Date of Birth *
MM
/
DD
/
YYYY
Address *
Please include City, State, and zip code
Employing Agency *
Job Title *
Work Phone
Primary Phone *
Email *
Lodge Number *
After filling out the above questions please submit this form and follow the prompts on the next page for payment. PLEASE PAY USING THE PAYPAL LINK ON THE NEXT PAGE!
A copy of your responses will be emailed to the address you provided.
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