FOP Application for Membership

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NAME:________________________ ___________________ ______________
                         (LAST)                                     (FIRST)                                   (MIDDLE)

ADDRESS: ___________________________________________________________________
                                   (NUMBER)                     (STREET)                     (CITY)                   (STATE)                 (ZIP)

DOB: _______________ SSN: _______________________

LAW ENFORCEMENT STATUS: ACTIVE _____ RETIRED_____ RANK:________

DATE OF HIRE:________________ RETIRED DATE:______________________

AGENCY: _____________________________ YEARS OF SERVICE:__________

DUTY PHONE: _________________ HOME PHONE: ______________________

INSURANCE BENEFICIARY: ____________________________________________
                                              (NAME)                                        (RELATIONSHIP)

MARITAL STATUS: ____________ CHILDREN UNDER 18 YEARS OF AGE (Yes/No)_______

F.O.P. OATH

I, _________________________________________ , in the presence of the Creator of the Universe and the members of the Fraternal Order of Police here assembled, do most solemnly and sincerely promise and swear, that I will to the best of my ability comply with all the laws and rules of this Order; that I will recognize the authority of my legally elected officers and obey all orders there from not in conflict with my religious or political views, or my rights as an American citizen; that I will not cheat, wrong, or fefraud this Order, or any member thereof, or permit the same to be done if in my power to prevent it; that I will at all times aid and assist a worthy Brother (or Sister) in sickness or distress so far as it lies in my power to do so; that I will not divulge any of the secrets of this Order to any one not entitled to receive them. To all of which I most solemnly and sincerely promise and swear. Should I violate this, my solemn oath or obligation, I hereby consent to be expelled from the Order.

________________________________________ _________________________
     (Applicant Signature)                                                                   (Date)

Send Membership Application with a $ 25.00 Check (no cash please) payable to:
“Las Vegas Lodge 1”
Mail to: PO Box 36426 Las Vegas, NV 89133-4626

--------------------------------------------------OFFICE USE ONLY----------------------------------------------------

Approved:: Date______________ Member #:__________________________

Denied/Reason:______________________________ Reinstatement Date: ______________

Remarks: ____________________________________________________________________