MEMBERSHIP APPLICATION

Dues for 2019 are Due, dues are $30.00 per year

and

$10.00 per year for "Life" members. 2019

Mail Dues to: 

10-13 Club of Northeast Fl

PO Box 4025

Enterprise, FL  32725

Click The Link Below To Download The Application

       PLEASE        PRINT       ALL        REQUESTED         INFORMATION

LAST NAME START TYPING____________________     FIRST _____________________   MI______

ADDRESS____________________________         CITY__________________ STATE_____
ZIP CODE_________    HOME PHONE (____  )________________       CELL (___)_______________ SPOUSE'S NAME _________________________    EMAIL  ADDRESS ________________________
BENEFICIARY'S   NAME  FOR  SURVIVOR’S  FUND  _____________________________                 
BIRTH DATE ____/____/______        ANNUAL DUES ARE
$30.00          CHECK #_____________
APPOINTMENT DATE____/____/_______                      RETIREMENT DATE ___/___/______ 

       $10.00 per year for "Life" members                                                                                                                           ATTACH Photo Copy  

                                                                                                                                         of  DEPT  ID
PENSION #(REQ'D)__________________   LAST COMMAND_____________  LAST RANK________
LIST ALL PREVIOUS COMMANDS     ___________________________________________________
                                                            ASSOCIATE  MEMBERS
LAW ENFORCEMENT AGENCY________________________TELEPHONE (      ) ________________
RANK_______            RETIRED (    ) ACTIVE (    )               MILITARY  ACTIVE   (    )     RETIRED (    )

I declare my desire for membership in the NE Fl. 10-13 club and to abide by the rules and constitution of the club.  Furthermore, I promise to remain a member in good standing and to submit my yearly dues on or about the 1st of January.  By affixing my signature below, I attest to the above as being true and to the best of my knowledge.                         

Signature______________________                                     Date ____ /_____ /_______

MAKE
CHECK PAYABLE TO:  
NE, FL 10-13    SEND to  PO Box 4025;  Enterprise FL 32725   

ALONG  WITH THIS APPLICATION
 

 

© 2018 by 10-13 of NE FL