Badgewives Membership Application

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.
Email*
example@example.com
Birthday*

MonthDayYear
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 *

MonthDayYear
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?

FundraisingCommunity OutreachPublic RelationsSocial EventsLeadership (Board of Directors)General MembershipOther
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

Clear

Annual Membership Dues

$30.00

Total

$0.00

Credit Card Details
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Credit Card Number	Security Code
Card Expiration

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