Membership Form

Type of Application

Applicant's Address

INSTRUCTIONS FOR COMPLETING THE APPLICATION

The above Membership Application is a fillable form, allowing the applicant to place the cursor in the box to be filled and typing in the necessary information.

  • Type of Application: 

    • Check the “New” box if this is the first time submitting an application for membership.

    • Check the “Renewal” box if you were a member in the past and are wishing to become a member again.

  • Name & DOB: self-explanatory.

  • Organization/Agency: Generally this would be the name of the police agency the applicant works for or retired from.

  • Job Title: Generally this would be the rank of the applicant.

  • Applicant’s Address & Contact Information: self-explanatory.

 

When all boxes have been completed, electronically sign and date below and hit the “SUBMIT” button

TERMS & CONDITIONS OF MEMBERSHIP

Thank you for submission! We will review each form at the next board meeting.  Once approved, we will contact the you to arrange for payment of the Membership Fee ($25.00) per year. Please email Cops4ACauseNY@gmail.com with any questions.

Applicant's Contact Information

Contact Us

P.O. Box 293

Vestal, NY 13851-0293

Cops4ACauseNY@gmail.com