Member Application

Member Application

FOP John Nelson Memorial Pasco Lodge 29
Name*

First NameMiddle NameLast NameSuffix
Home Address*

Street Address

Street Address Line 2

CityState

Zip Code
County*
Personal Email*
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Mobile Phone Number*
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Date of Birth*

MonthDayYear
Date
Sex*
Current or Former Agency
If "Other" please enter in the space provided below.
"Other" Agency
Work location (if applicable):
Status
Additional Information:
Member Oath
I, First Name Last Name (enter full name) in the presence of the creator of the universe and the members of the Fraternal Order of Police here assembled, do most solemnly and sincerely promise and swear, that I will to the best of my ability comply with all of the laws and the rules of this order; that I will recognize the authority of my legally elected officers and abate all orders there from not in conflict with my religious or political views, or my rights as an American citizen; that I will not cheat, wrong, or defraud this order, or any member thereof, or permit the same to be done if in my power to prevent it; that I will at all times aid and assist a brother or sister in sickness or distress, so far as it lies in my power to do so; that I will not divulge any secrets of this order to anyone not entitled to receive them. To all which I most solemnly and sincerely promise and swear. Should I violate this, my solemn oath or obligation, I hereby consent to be expelled from the order.
Signature Date
Membership Level (select one):*

Fraternal Only (retirees / non-sworn)Fraternal + Legal Defense (Captains and above)Fraternal + Legal Defense + Labor Union (Below rank of Captain)
LABOR/LEGAL DEFENSE APPLICATION

Not available to retirees / non-sworn personnel
I hereby apply for enrollment in the FOP-FL Labor Council Committee Labor/Legal Defense Plan (LDP), and agree to abide by all the terms and conditions thereof. I understand that no coverage is in effect until this application is approved by my Lodge President. To my knowledge, I am not presently named in any suits, action or proceeding or under investigation for a duty-related incident with the following exception (if not applicable, enter N/A):
Emergency Contact
Name

First NameLast Name
Relationship
Phone Number
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Signature

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Last 4 of SSN:
Date*

MonthDayYear
Date
PSO Payroll Deduction Form

Required for active PSO personnel.
Complete, sign and upload file below.
ZPD Payroll Deduction Form

Required for active ZPD personnel:
Complete, sign and upload file below.
All Members: Standard Life Insurance

Included at no additional cost with all membership levels.
Complete, sign and upload file below.
Legal/Labor Union Members Only

Line of Duty Life Insurance
Complete, sign and upload file below.
File Upload

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Application Fee

New member application fee $25.00
Should be Empty:

Member Application

Member Oath

LABOR/LEGAL DEFENSE APPLICATION

Emergency Contact

PSO Payroll Deduction Form

ZPD Payroll Deduction Form

All Members: Standard Life Insurance

Legal/Labor Union Members Only

Application Fee