Fraternal Order of Police Northwest Lodge No. 123

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To the Officers of the Fraternal Order of Police:

I, the undersigned, a regularly employed law enforcement officer, do hereby make application for Active Membership.

If my membership should be revoked or discounted for any cause other than retirement while in good standing, I do hereby agree to return to said Lodge my membership card and any other material bearing the F.O.P. Insignia, such as auto emblem, lapel pin, etc.

First Name, Middle Initial, and Last Name *

Home Address *

Cell Phone Number and Email Address *

Employer to include: Police Department Name, Rank, Phone Number, and Address *

I agree that this information is true and I agree to these terms. *

Yes

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