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 *
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. *
Required
Last Name *
First Name *
Email Address *
Street Address *
City *
State *
Zip Code *
Cell Phone Number *
Alternate number (not required)
Career *
Status *
Date Retired if applicable
MM
/
DD
/
YYYY
Department *
Rank *
Shield Number *
Sponsor Name *
Sponsor Department *
On what do you base your Irish ancestry? (Include county if known)
 *
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

 *
Required
A copy of your responses will be emailed to the address you provided.
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