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Membership Application
To be a member of the Essex County Emerald Society, you must be a full time or retired law enforcement officer or a career firefighter. Please fill out this membership application and the Vice President in charge of membership will contact you.
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Email
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Your email
I hereby apply for membership in the Emerald Society of the State of New Jersey, and make each of the following statement of facts, personally known to me, intending that the Society reply upon the truth of each in acting upon this application.
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I agree
Required
Last Name
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Your answer
First Name
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Your answer
Email Address
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Your answer
Street Address
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Your answer
City
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Your answer
State
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Your answer
Zip Code
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Your answer
Cell Phone Number
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Your answer
Alternate number (not required)
Your answer
Career
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Law Enforcement
Fire Service
Status
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Currently serving
Retired
Date Retired if applicable
MM
/
DD
/
YYYY
Department
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Your answer
Rank
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Your answer
Shield Number
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Your answer
Sponsor Name
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Your answer
Sponsor Department
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Your answer
On what do you base your Irish ancestry? (Include county if known)
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Your answer
If elected to membership, I agree to abide by and be governed by the present Constitution and By-Laws of the Emerald Society and any future amendments, modifications and changes thereto.
Check the box below if you agree
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I agree
I disagree
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A copy of your responses will be emailed to the address you provided.
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