Badgewives Membership Application

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Cell Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Birthday

Date

Facebook Name

Were you referred by a current member? If so, please list their name.

Name of Spouse/Significant Other

Spouse/Significant Other Agency

Please list full agency/department name rather than using abbreviations.

Years of Service at current agency

Total Years in Law Enforcement

Marriage/Relationship Anniversary Date

Date

Number of Children

Ages

Current Afflictions (clubs, churches, other non-profit organizations, etc.)

Hobbies, talents, special interests:

Do you have a specific area of the organization that you are interested in participating?

Photo Release: I hereby grant BadgeWives of Tampa Bay Inc. the right to take photographs of me, my significant other, and children, if applicable, during any group event that I am present for. I agree that BadgeWives of Tampa Bay Inc. may use such photos for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and web content. I will make no monetary or other claims against the Photographers / BadgeWives of Tampa Bay Inc. for the use of the photograph(s)

Acknowledgments: I agree to pay the annual membership fee of $30 to join BadgeWives of Tampa Bay Inc., to be an active member, and to abide by the Bylaws. I also agree when collecting donations on behalf of BadgeWives whether monetary or tangible goods, that I am required to turn them into the organization. I agree to read and abide by the social media group guidelines if I choose to join the social media group. My signature also authorizes BadgeWives of Tampa Bay Inc. to verify my law enforcement affiliation if necessary.

Signature

Annual Membership Dues

$30.00

Total

$0.00

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