Post Falls FOP Lodge #42 Membership Form

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I am a full-time regularly appointed or elected law enforcement officer OR law enforcement support employee OR retiree, and do hereby make application for membership in Post Falls FOP Lodge #42. Annual dues/costs shall be set at $350.00; $120.00 for retirees. If you are a current FOP member in another lodge, we will contact you about payment of dues. Fees will be discussed further in this membership form.

Membership in the lodge includes membership in the PORAC Legal Plan. Retirees will be enrolled in the PORAC retiree LEOSA legal plan.

First Name *

Middle Name

Last Name *

Date of Birth *

YYYY

Home address *

City *

State *

Zip *

Personal Email Address *

Phone number *

Last four of SSN *

What agency do/did you work for? *

What is your employment status? *

Full time sworn LE

Full time non-sworn LE support staff

Retired

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