ASSOCIATE MEMBER APPLICATION
Associate Black Shield members are members of the public who support the mission of The Black Shield. Membership dues are $5/month. Dues are collected at the time of acceptance.

The Black Shield reviews applications on the 15th of every month. You will receive notification via email.
Email address *
First and Last Name *
Street Address, City and State *
Phone number *
Who is your Black Shield Police Association reference name? *
Please denote a current Black Shield Police Association member who will serve as your personal reference.
Are you interested in volunteering with the Black Shield Police Association? *
A copy of your responses will be emailed to the address you provided.
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This form was created inside of The Black Shield.