MEMBERSHIP APPLICATION

Dues for 2022 are Due, dues are $30.00 per year
and
 "Life TIME"  Members PAY $10.00  Assessment

Mail Dues to: 

NEW  ADDRESS 

10-13 Club of Northeast Fl

PO Box 291862

  Port Orange, FL  32129 

Click The Link Below To Download The Application

  PLEASE        PRINT       ALL        REQUESTED         INFORMATION
LAST NAME ____________________     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 ___/___/______ 

                                                                                                                                          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 (    )

                        

Signature______________________                                     Date ____ /_____ /_______


MAKE CHECK PAYABLE TO:  NE, FL 10-13  SEND to  PO Box 291862,  Port Orange FL  32129

ALONG  WITH THIS APPLICATION 
 

Recognized by the US Congress, the NYS Assembly, and  the  NYS Senate, as the representative union of retirees of  ALL ranks of NYCPD      http://nationalnycpd1013.org/