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Wisconsin FOP Per Capita Payment Authorization for Adding Members

This form must be completed by the local lodge secretary or another authorized lodge officer responsible for handling membership or financial transactions for your lodge. The necessary funds for the State and National Lodge per capita and associated fees will be deducted from the bank account on record. An electronic receipt will be sent to the registered email address.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Lodge Name*
Number*

New Members Added

Members must be added to the membership database prior to completing this form.
New members will be charged for the half year they are added during, in addition to the the period the lodge is currently paid through at the most recent annual per capita period.

First Half: January 1st through June 30
Last Half: July 1 through December 31

Full Year: $20.00 Wisconsin FOP + $11.50 National FOP = $31.50
Half Year: $10.00 Wisconsin FOP + $5.75 National FOP = $15.75
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I hereby authorize the Wisconsin State Lodge, Fraternal Order of Police, to initiate an ACH debit from the bank account on file for the payment of State and National per capita and associated fees for the number of members indicated above.*

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Wisconsin FOP Per Capita Payment Authorization for Adding Members

New Members Added