FOP Fox Valley Area Lodge 14 Membership Application

FOP Fox Valley Area Lodge 14 Membership Application
Name

First NameLast Name
Email
Personal Email Preferred
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth

MonthDayYear
Date
Employment Status
Law Enforcement Agency
If retired, list agency you retired from.
Title
Employed Since

MonthDayYear
Date
Referred by (Optional)
If you were referred by a current WI FOP member, please list their name.
Please upload your law enforcement credentials

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Membership Options
Please select your membership class and legal defense plan coverage, if desired. See foplegal.com for more information on the Legal Defense Plan options. Memberships will be prorated by 50% if joining after July 1. Legal Defense Plan fees will be prorated monthly to end December 31.
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Active Membership
This is for regularly appointed and full-time active law enforcement officers of the United States or a political subdivision thereof.

$60.00



Retired Membership
This is for law enforcement officers who retired from their agency in good standing.

$35.00



Associate Membership
This is for civilians, including friends and family members of law enforcement officers, business people, and other citizens who want to support the FOP's goals and objectives.

$40.00



FOP Legal Defense Plan - Civil/Criminal
Civil/Criminal coverage for Active or Associate Members employed by a federal, state, or local law enforcement agency.

$84.00 Quantity



FOP Legal Defense Plan - Administrative/Civil/Criminal
Administrative/Civil/Criminal coverage for Active or Associate Members employed by a federal, state, or local law enforcement agency.

$396.00 Quantity



Total

$0.00
Last 4 of SSN
Needed if signing up for legal defense plan
You will receive an invoice for annual dues and legal defense plan fees through Quickbooks. Membership will be activated upon verification of law enforcement status and receipt of payment. Memberships activated between January and June will be charged the full amount. Memberships activated between July and December will be prorated at 50% for the remainder of the first year. Legal Defense Plan fees will be prorated by month for the calendar year.
Emergency Contact Info
Emergency Contact

First NameLast Name
Emergency Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
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FOP Fox Valley Area Lodge 14 Membership Application

Membership Options

Please select your membership class and legal defense plan coverage, if desired. See foplegal.com for more information on the Legal Defense Plan options. Memberships will be prorated by 50% if joining after July 1. Legal Defense Plan fees will be prorated monthly to end December 31.

Emergency Contact Info