GEORGIA STATE CORRECTIONS FRATERNAL ORDER OF POLICE
LODGE #102
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GEORGIA STATE CORRECTIONS FRATERNAL ORDER OF POLICE LODGE #102 |
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Membership
Application
Application Georgia State Corrections Lodge #102 www.georgiastatecorrectionslodge102.org_____________ Date Name: _______________________________________________________ Address:______________________________City:_____________State:______Zip:_________ Phone:______________________E-mail:_______ DOB: _______________________________ Agency:____________________/________________City________________State:______Zip:_____ Co Corrections/Probations/Parole Check if retired law enforcement: Yes___ No___ Applicant’s Signature_______________________________________ $40 per fiscal year (Oct. 1st- Sept 30th) $20 (If joining within 6 month’s of end of fiscal year (Apr. 1st - Sept. 30th, then $40 to be current for new fiscal year starting Oct.1st) Retired Members: $20 per year All member’s of the FOP receive a $1000 life insurance policy as part of their membership _____________________________________________________________________________________ Beneficiary Information Name of Beneficiary(s):________________ Street Address:__________________________ City/State:_________________ Zip:_________ _____________________________________________________________________________________ Mail dues to: Mary Barnes C/O Treasurer GA FOP Lodge 102 P.O. BOX 203 WAYCROSS, GA 31501 Please make your check or money order payable to Georgia State Corrections Lodge #102 ____________________________________________________________________________________If you are interested in joining the Legal Defense Plan please contact the Georgia State Lodge for cost and more information. 1-800-305-0237 __________________________________________ (Submitted by: Lodge use only) |