American Malayalee Law Enforcement United (AMLEU) Membership Application - $100 for Individuals (Active Law Enforcement / Retired Law Enforcement / Associate Member) - $500 for Businesses
Membership Application
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First Name *
Last Name *
Nick Name
Email *
Address: Street *
Address: City *
Address: State *
Address: ZIP *
Cell Phone Number (XXX-XXX-XXXX) *
Business Phone (XXX-XXX-XXXX)
Active Law Enforcement - Retired Law Enforcement - Associate Member *
Date of Birth (MM/DD/YY) (For Law Enforcement Only)
Law Enforcement Agency Active in or Retired From (For Law Enforcement Only)
Address of Agency (For Law Enforcement Only)
Law Enforcement Rank / Title / Assignment etc. (For Law Enforcement Only)
Date First Entered Law Enforcement (MM/DD/YY) (For Law Enforcement Only)
Date Retired From Law Enforcement (MM/DD/YY) (For Law Enforcement Only)
Military Veteran (For Law Enforcement Only)
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Business Name of Associate Member
Business Address of Associate Member
Website
How did you hear about AMLEU? *
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