Police Association of south jersey
Regular Associate Family** Organization***
New Membership Renewal Membership
ID #: Required for renewal
Name: (Jr., Sr.) D.O.B.
Address:
City: State: Zip:
Phone No.:
Occupation:
E-Mail Address:
N.R.A. Membership #: Expiration Date:
***Organization/Department:
***Badge #: Years of Service:
Are you now or have you ever been a member of any other Organization and or Association?
Please list them below, along with dates of service.
Organization and or Association
Date
** If you are applying for a family membership, please list the full names of the persons, along with relationship and ages below. We only allow up to (4) people for this membership. Under the “Family Membership“, any persons under 18 years of age, must be accompanied by a parent, or legal guardian. No children under the age 12 are permitted.
Name
Relationship
Age
None Wife Husband Child Mother Father
None Wife Husband Child Mother Father Sister Brother
*** If you are applying for an Organization/Department Membership, please provide a list of all members on department letterhead, and attach it to the back of this application.***
(*** Law Enforcement Badge # & Rank Only***)
********************** AGREEMENT **********************
I, the undersigned, declare that the information given is true. I also understand that if any of the information on this application is false, I WILL be denied and removed from the membership.
I also agree to abide to ALL the range rules, fees, and charges as set forth in the bylaws of “The Police Association of South Jersey.” By signing this application I acknowledge that, I, and any persons listed on this application have read and understand all the range rules, fees, and charges. I also agree that ANY board member, range officer, or member SHALL NOT be held legally responsible for any of my actions or the actions of any of the persons listed under my membership or any person listed as my guest. Whether it is at the range, on the property, or at any event that I attend as a member of the “Police Association of South Jersey”.
I acknowledge that participation in a work detail is required as part of my membership in the “Police Association of South Jersey”. I agree that failure to participate will result in a forfeiture of my maintenance bond and that I will be required to pay a new maintenance bond at the renewal of my membership. Waiver for exclusion must be presented in writing to the judicial committee.
I acknowledge that I am responsible for any and all damages that any of the persons listed under my membership or any person listed as my guest may cause.
I understand and agree with the agreement above
Signature: _______________________________________ Date: __/__/__
Please print this form (Before you press submit), sign and mail with your check.
PASJ Membership Application *
Guest Policy *
Work Detail Policy *
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