ASSOCIATE MEMBER APPLICATION

ASSOCIATE MEMBER INFORMATION
First Name:*
Last Name:*
Middle:
Address:
City:
State:
Zip:
Phone:*
Email:*
Please do not use a government email address (.gov)
FOP Lodge #82 Sponsor Information
Please complete the information below regarding your sponsor.
Sponsor Name:*
As your sponsor, the above must be an active member in good standing of the Sgt. D.P. Land Lodge #82 of the Fraternal Order Of Police. They do hereby attest to the character and morals of this applicant to be consistent with the character and morals required of a Member of the Fraternal Order Of Police and the applicant has proven to be a friend of law enforcement and is worthy of Fraternalism in our lodge as an Associate Member of the Sgt. D.P. Land Memorial Lodge.
Electronic Signature*
I, the applicant for Associate Lodge Membership, warrant the truthfulness of the information provided in this application. I understand that my electronic signature (above) constitutes a legal signature confirming that I acknowledge and agree to the Terms of Acceptance.
Dues Information
Associate Member Annual Dues
Price:
Total:
$0.00

SGT. D.P. Land Memorial Lodge #82
Fraternal Order Of Police

SGT. D.P. Land Memorial Lodge #82
Fraternal Order Of Police

Mailing Address:
Post Office Box 1374
Cumming, Georgia 30028

Physical Address:
248 Castleberry Industrial Dr
Cumming GA 30040

ASSOCIATE MEMBER INFORMATION