NCFOP Lodge 97 Application Form

Davidson County FOP Lodge 97

Membership Application
Membership Type:*

Active Member $190Affiliate Member $190Retired Member $75Associate Member $55Transfer MembershipUpdate Information
Applicant's Name:*

First NameMiddle NameLast NameSuffix
Applicant's Address:*

Street Address

Street Address Line 2

CityState

Zip Code
Applicant's Phone Number:*
Please enter a valid phone number.
Applicant's Email:*

Confirmation EmailPlease use an email you will check
Applicant's DOB:*

MonthDayYear
Applicant's SSN:*
123-45-6789
Agency Name:*
Please DO NOT abbreviate: TPD
Applicant's Position:*
Police Officer, Detention Officer
Agency Address:*

Street Address

Street Address Line 2

CityState

Zip Code
Agency Phone Number:*
Please enter a valid phone number.
I understand the legal defense plan will not go in effect until the first day of the next month after my application is accepted by the NC State FOP Lodge. If I do not follow the outlined steps for the legal aid plan (https://www.ncfop97.org/legal), I understand the lodge, its members nor its executive officers are responsible for any legal fees stemming from any actions connected with my employment. Any actions taken on my part will be at my own expense.
I understand & accept the above statement*

Yes
STATE/LOCAL LODGE DONATION ASSIGNMENT: In the event of an untimely death, either natural or line of duty, I designate the following beneficiary(s) to receive any and all funds entitled to me as a member of the Fraternal Order of Police, if any.
I understand & accept the above statement*

Yes
Beneficiary Name:*

First NameMiddle NameLast Name
Beneficiary Address:*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Beneficiary's SSN:*
123-45-6789
Beneficiary's Phone Number:*
Please enter a valid phone number.
Applicant's Obligation:

I, [THE AFOREMENTIONED APPLICANT], 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 laws and rules of this Order; that I will recognize the authority of my legally elected officers and obey all orders therefrom 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 worthy brother or sister in sickness or distress so far as it lies in my power to do so; and that I will not divulge any secrets of this Order to anyone not entitled to receive them. To all of 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.
I accept & submit myself to the FOP Obligation.*

Yes
Method of Payment:*

PayPalCheckCashACH Debit (Must pay first year upfront)
Applicant's Signature:*

Clear
This "Electronic" Signature hereby stands as my written signature for all legal purposes.
Please verify that you are human*
Should be Empty:

Davidson County FOP Lodge 97