New Membership Application PERSONAL INFORMATION Name - Required Email Address - Required Phone Number - Required Date of Birth - Required Your Address Address Line 1 Address Line 2 City State ZIP Code Your Spouse or S.O. or Relative Your Religion (for Bible Fund) Wedding Anniversary Sponsor Name (if no sponsor please type "NONE") - Required NYCPD Information Date Appointed Date Retired Rank Latest or Last Command - Required Previous Commands Are you Active NYCPD? Check if Active NYCPD RETIREMENT TYPES: (Please check appropriate box below) Service Vested Ordinary Disability Accidental Disability (L.O.D.) Please use this area below for information you want to share (I.e. Current Occupation, or Services you may want to Provide. etc.) Pay Dues Online ($35.00) - All New Members Receive a Minimum 15 Months Membership Check this box to pay dues now – $35 Submit Please Wait…
