UNITED FEDERATION OF SPECIAL POLICE
AND SECURITY OFFICERS, INC.
INDIVIDUAL MEMBERSHIP APPLICATION/RENEWAL FORM
I certify that I am an (active/retired) Registered Security Officer in the State of ______________ and, as such, I (apply for/renew my) membership in the United Federation of Security Officers, Inc. I understand that my dues for the period of 12 months will be $26.00. I understand that I will receive a membership card and window sticker. I further understand that these dues entitle me to participate in all the programs for individual members of the United Federation of Security Officers, Inc. pursuant to the by-laws and subject to the cost, rules and procedures of said programs.
I understand that as a New York State (active/retired) member I may also voluntarily participate in the Federations of Police Political Action Committee (PAC) fund for New York State, which enables the Federation to financially support elected officials who support the Federation legislative program. Copies of the required FOPPAC campaign financial disclosures are on file and available from the New York State Board of Elections. An optional contribution of $10.00 is suggested, though contributions in any amount will be gratefully accepted.
All correspondence will be sent to the address provided below.
________ $26.00 DUES _________ $10.00 PAC CONTRIBUTION (OPTIONAL)
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REQUIRED INFORMATION:
NAME______________________________________ **TELEPHONE______________
STREET____________________________________________________Apt______
CITY____________________________________STATE_____ZIP CODE___________
SECURITY
EMPLOYER____________________________________RANK/TITLE_____________
SIGNATURE__________________________________________DATE_____________
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OPTIONAL INFORMATION
:*SEX_____*DATE OF BIRTH________________**SOCIAL SECURITY#________________________
* This information used for census data requested by insurance companies for quotes to obtain lower rates.
** Social Security number used for identification only. Telephone # & SS# confidential - NOT given out.
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Return this application, with your DUES and optional PAC contribution to:
UNITED FEDERATION OF SECURITY OFFICERS, INC. PO BOX 76 BRIARCLIFF MANOR, NEW YORK 10510-0076You may have a printer friendly copy of this form if you have Adobe Acrobat Reader installed on your computer. If you do not have Adobe Acrobat Reader, you may download it, at no charge, from www.Adobe.com