Fraternal Order of Police Capitol City Lodge #19
Associate Membership Application

Full Name ____________________________________________________________

Date of Birth ________________________

Address _____________________________________________________________

City ________________________ State __________________ Zip ___________

Phone Number ___________________ Best Time to Call _________________

E-Mail _______________________________________

Agency ___________________________________ Rank ____________________

To the Officers of the Fraternal Order of Police

I the undersigned am a local business person or Law Enforcement Supporter in good standing in this community. My personal background is free of any Felony convictions. I do hereby make application for an associate membership in the Capitol City Lodge No. #19.

If my membership should be revoked or discontinued for any cause other than my resignation while in good standing, I do hereby agree to return to said Lodge my membership card and any other material bearing the FOP insignia (i.e. auto emblem, lapel pin etc.)

Signed:_______________________________ Date:___________________________

Lodge dues $40.00 per year cover national state and local dues as well as all other benefits of membership.

Print, sign and send this application with your Dues to:

Jeff Wolfe
3646 SW Grotto Ct
Port Orchard WA 98367