| FOP 84 Western Hamilton County 2012 Membership dues Please print this form and mail it with your dues, or turn it in at the next meeting. Enclosed are my dues for 2012 FOP membership. Membership dues are due NO LATER than February 1, 2012 or your status will be changed to SUSPENDED. Dues received after that date will have a $5.00 late fee added. Name:_____________________________________Department: __________________________ Please print Home address:__________________________________________________________________ Phone number:__________________________________________________________________ email:__________________________________________________________________________ Active: $50.00 _________________ Retired: $30.00 ________________ Please mail this form and a check made payable to: FOP Lodge 84 Bob Uhl c/o Cheviot Police Dept. 3814 Harrison Avenue Cheviot, Ohio 45211 ******************************************************************************************************************************** If you no longer wish to be a member of FOP 84, please indicate below and mail to the above address. _________ I do not wish to remain an active member in FOP Lodge 84. Please remove my name from your roster. Name: ____________________________________________________________ Please print Signature: _________________________________________________________ Thank you! |