New Recruit Active Member Application

$200

New Recruit Discounted Rate

$200.00

This discounted rate is offered only to new members who enroll in payroll deduction and applies to the first membership year. You will have every benefit including the FOP's Legal Aid plan. The normal yearly rate is $230.00 and is what the weekly payroll deduction rate is based on.

First name

Last name

Multi-line address

Country/Region

Address

City

Zip / Postal code

Personal Email

**Please use your personal email address and not your agency email address. If you ever apply for legal aid, we do not want any information to be obtained by your employer or a public record's request.

Phone

Birthday

Month

Day

Year

Last 4 of SSN

Sex

Male

Female

Other/Unlisted

Each FOP Lodge #9 Member has a line of duty death benefit and Accidental Death & Dismemberment coverage. These policies pay out when a member dies in the line of duty or is injured in accordance with our policy. Please provide us with your beneficiary information.

Beneficiary Name (first & last)

Beneficiary Last Name

Beneficiary Phone Number

Beneficiary Relationship

CMPD employees can enroll in payroll deduction and have their FOP dues taken in weekly deductions of $5.00. You will pay the $200 today, and weekly deductions will begin within a month after graduating from the academy. Today's payment pays for your FOP membership for the current year. We collect via payroll deduction, so when next year's dues need to be paid, we will have already received them. Enrolling in payroll deduction ensures you will never go without coverage, and your membership automatically renews each year.

Do you want to enroll in payroll deduction?

Yes

What is your employee number? (NOT your CMPD code number)

By clicking "I agree" below, I, 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 the 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 that I will not divulge any of the secrets of this Order to anyone not entitles 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 agree

Signature

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