10-13 is Home Page

Det Alverez.jpg

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

MEMBERS APPLICATION July 2018.docx

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 AGENCYTELEPHONE (    )
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