Rose Island FOP 206 Associate Membership Application

ROSE ISLAND FOP 206

CHARLESTOWN, INDIANA
Associate Membership Petition 2025
SELECT ONE: **Membership is valid for one year (12 months).

NEW Associate Membership ($50.00)RENEWAL Associate Membership ($50.00)Transfer
Current Lodge Transfer (If applicable)
**Transfer requests must also include a letter from your current lodge indicating you are in good standing. All categories must be completed to be considered.**
Associate Membership: Associate membership may be open to any persons twenty-one (21) years of age or older, of good moral character and who is not a regular police officer. Associate membership is a privilege. Associate membership may be permitted, denied or revoked at the pleasure of the Executive Board.
Contact Name and Address:

All information is held in confidence. One membership application per submission.
Name*
DOB
Mailing Address*
City*
State*
Zip Code*
Email*
example@example.com
Phone Number*
So that we can contact you if needed. Your Phone Number will be held in confidence.
I swear and affirm that all of the above information is true and accurate to the best of my abilities and understand that intentionally falsifying any portion may result in the penalty of a period where no petitions will be accepted from the applicant of not less than one year.
Signature

Clear
Date

MonthDayYear
Date
Pay Membership Dues via Venmo:

All fees are 100% refundable if membership is not approved. Use the following FOP 206 Venmo information and QR code to make your payment BEFORE CLICKING SUBMIT BELOW.
FOP 206 Associate Membership for 2025*
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FOP 206 Associate MembershipOne year membership
$50.00

Total

$0.00
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ROSE ISLAND FOP 206

Associate Membership Petition 2025

Contact Name and Address:

Pay Membership Dues via Venmo: