Please fill out this application in full and print it out on your computer and send it with your dues.
 Please make check payable to:
The Italian American Police Society of New Jersey Inc.   and mail to
P.O. Box 352
Lyndhurst NJ 07071.
Membership dues are $25.00 per year
 
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 First Name:    MI:     Last Name:    Date of Birth:
Department:    Rank:

                   If applying for Associate Membership please provide:

                   Company: Title:


   Address line1:      Address line 2: 
                    City:  State:   Zip:   (please use Zip Plus 4 when possible to ensure mail delivery. Also notify us of any changes)
E-mail Address:  Please provide Email address, they are never published and are used for IAPSNJ only.
Is your Italian Heritage at least 50% (yes or no): If no, explain
Marital Status: (yes or no)Spouse's Name:
The folowing information will not be published in any way and is only for IAPSNJ use. Please provide Cell Phone Carrier for Cell Alerts

 Home Phone:          Work Phone:                      Beeper:     Beeper PIN (if any): 
    Home FAX:             Work FAX: 
    Cell Phone:            Cell Carrier: 
Union Affiliation:  If you are an officer in your union, what is your Title:

Any Questions on membership, contact us