APPLICATION FOR HONORARY MEMBERSHIP

Application for Honorary Membership

I HEREBY APPLY FOR HONORARY MEMBERSHIP IN THE LONG BEACH POLICE OFFICERS ASSOCIATION. I UNDERSTAND THIS IS JUST A PRELIMINARY APPLICATION THAT DOES NOT GUARANTEE ACCEPTANCE AS AN HONORARY MEMBER.

MY APPLICATION WILL BE REVIEWED BY THE BOARD OF DIRECTORS, AT WHICH TIME EITHER AN ACCEPTANCE OR REJECTION NOTICE WILL BE FORWARDED TO ME WITHIN 60 DAYS.

First Name(*)

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Last Name(*)

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Address(*)

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City(*)

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State(*)

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Zip Code(*)

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Phone Number(*)

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Email Address(*)

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Gender

FemaleMale Invalid Input

Date of Birth (MM/DD/YYYY)(*)

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Employed By(*)

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Occupation(*)

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Work Address(*)

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City(*)

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State(*)

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Zip Code(*)

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Work Phone Number(*)

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I WOULD PREFER TO HAVE MY MAIL SENT TO MY:

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HAVE YOU EVER BEEN CONVICTED OF A MISDEMEANOR OR FELONY?

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YesNo Invalid Input

IF YES, PLEASE PROVIDE DETAILS (CRIME CHARGED, MONTH AND YEAR) BELOW.

(*)

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NOTE: MEMBERSHIP DUES ARE PAYABLE UPON ACCEPTANCE. MEMBERSHIP IS RENEWABLE JANUARY 1ST OF EACH YEAR.

Sponsor's Email

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