APPLICATION FOR MEMBERSHIP IN LOCAL 16

MEMBERSHIP APPLICATION

I hereby make application for membership in the Atlantic County Retired Police and Firemen’s Association, Inc. of the State of New Jersey, and swear, if admitted, to abide by the associations’ constitution and by law.

When you submit your online application, you will receive an email back in the email account you used to fill out the form confirming the information you submitted.   Please verify the information in the email and forward to the email address indicated in the email.

Last Name

First Name

Address

City

State

Zip

Home Phone

Cell Phone

E-Mail Address

Retired From

Affiliation Local

Next of Kin

Last Name:

First Name:

Relationship

Address

City

State

Zip

Phone

Date of Application

Method of Payment Check Mailed Venmo to @ACRPoliceFireAssoc

For Security - Please enter Code loc#16



Yearly dues of $30.00. Please remember to submit your payment by check made payable to:

Atlantic County Retired Police and Firemen’s Assoc. Inc.

Applications may be mailed to Secretary: Joe Yulick, 315 Cos Cob Dr., Galloway, N.J. 08205

Venmo Payments sent to @ACRPoliceFireAssoc

   Scan to Pay via Venmo

Last Name
First Name
Address
City
State
Zip
Home Phone
Cell Phone
E-Mail Address
Retired From
Affiliation	Local
Next of Kin Last Name:
First Name:
Relationship
Address
City
State
Zip
Phone
Date of Application
Method of Payment	Check Mailed Venmo to @ACRPoliceFireAssoc
	For Security - Please enter Code loc#16