Pennsylvania Eastern Chapter, FBI National Academy Associates
LIFETIME MEMBERSHIP APPLICATION RENEWAL
This form needs to be completed in its entirety in order to request lifetime membership with the Eastern Pennsylvania FBINAA Chapter. Lifetime membership will be offered as long as the FBINAA Eastern PA Chapter is financially sound. In order to be considered for lifetime membership, you must have been a member in good standing of the FBINAA Eastern PA Chapter for twenty-five consecutive years and retired from full time law enforcement. Once you have completed this form it will be submitted to the FBINAA Eastern PA Executive Board for review.
The application will be taken under consideration at the next Executive Board meeting, and you will be notified. The Executive Board as the right to reject any and all applications or to eliminate this program at any time it is deemed necessary.
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
NA Session #
Are you currently designated a Life Member of the Pennsylvania Eastern Chapter of the FBINAA?
Yes
No (If no please return to the main page and complete click the link for the "Lifetime Membership Application")
Have you become employed in law enforcement since your last application?
Yes
No
Full Time
Part Time
Name of New Department
Years of service from
to
.f
Address of New Department
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you wish to remain a Life Member of the Pennsylvania Eastern Chapter of the FBINAA?
Yes
No
Signature
Date
-
Month
-
Day
Year
Date
Continue
Continue
Should be Empty: