Annual Membership Renewal
Member Name
*
First Name
Last Name
Business/Organization Name
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
I would like to pay by:
*
Credit Card
Agency Payroll Deduction (St. Lucie Sheriff & St. Lucie Fire District Employees Only)
Corporate/Personal Check (Mailed to PO Box 13628 Fort Pierce, FL 34979)
Prefered method of renewal notification:
*
US Mail
Email
I would like to pay using payroll deduction from my employer
St. Lucie County Sheriff's Office
St. Lucie County Fire District
Please select one:
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Corporate Lifetime Membership
Enter description
$
5,000.00
Quantity
1
2
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7
8
9
10
Lifetime Membership
$
2,000.00
Quantity
1
2
3
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8
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10
Annual Corporate Membership
$
500.00
Quantity
1
2
3
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5
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10
Annual Individual Membership
$
100.00
Quantity
1
2
3
4
5
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9
10
Annual First Responder Membership
Active or retired
$
50.00
Quantity
1
2
3
4
5
6
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8
9
10
Annual First Responder Membership
Payroll deduction
$
50.00
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card
Please direct any questions to 100clubslc@gmail.com
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