APPLICATION FOR MEMBERSHIP

APPLICATION FOR MEMBERSHIP

NYCD EMERALD SOCIETY INC
Regular Membership-Irish Ancestry

Associate Membership-Irish Spirit

*NYC Correction Department MOS or Civilian employees only*

I HEREBY APPLY FOR MEMBERSHIP IN THE NYCD EMERALD SOCIETY INC. AND MAKE EACH OF THE FOLLOWING STATEMENTS OF FACT, PERSONALLY KNOWN TO ME, INTENDING THAT THE SOCIETY RELY UPON THE TRUTH OF EACH IN ACTING UPON THIS APPLICATION.
Name*

First NameLast Name
Rank/Title*
Shield or ID #*
Command*
DOB*
DOA*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Mother's Maiden Name*
Father's Name*
On what do you base your Irish ancestry? (Regular Membership)*
If you have none write none
I do not have Irish ancestry but Irish Spirit and wish to be an Associate member because
Signature*
DATE*

MonthDayYear
Date
My Products
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Application to Join/2024 dues donation
Regular Membership-Irish AncestryAssociate Membership-Irish Spirit*NYC Correction Department MOS or Civilian employees only*

$38.00

Total

$0.00
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