Application for Associate Membership
Carmel Lodge No. 185
P.O. Box 3142
Carmel, IN 46082
I,
, am applying for membership as an Associate
Member of The Fraternal Order of Police, Carmel Lodge 185, and the following
information is submitted concerning myself:
Full Name: (Last)
(First)
(M)
E-Mail Address:
@
(if applicable)
Age:
Birthplace:
Birth Date:
//
Social Security Num:
-- Home Phone #: ()
-
Street Address:
City:
State:
Zip:
Occupation:
Employer’s Name:
Employer's Address:
City:
State:
Zip:
Have you ever been
arrested other than having a traffic citation?
.
If you answered “Yes” please explain the charges and circumstances surrounding
the arrest.
.
Have you ever
been denied membership into the Fraternal Order of Police? .
(If “Yes”
please explain):
.
I swear that the above
information is true to the best of my knowledge and that this information will
be held in confidence, and I understand that if I am accepted into the
Fraternal Order of Police, I will support the Lodge and bring credit upon the
Membership of the Lodge.
I further understand that
all emblems and decals furnished to me by the Lodge are the property of the
Lodge, and if my membership is revoked or I choose to withdraw my membership I
shall return such emblems and decals to the Lodge.
Signature of Applicant:
______________________________________________________
Recommend by:
Date: //
APPLICATION MUST BE FILLED
OUT COMPLETELY and must be accompanied by a check, money order, or cash in the
amount of $25.00 for the first year’s dues. Make check or money order payable
to the Fraternal Order of Police Lodge 185. (Renewal is at the first of each
year)
________________________________________________________________________________________________________________
To be completed by the membership committee
ONLY.
The membership committee has investigated the
above applicant and recommends that the applicant.
(BE ACCEPTED) or
(BE DENIED)