The New Jersey National Latino Peace Officers Association

ONLINE MEMBERSHIP APPLICATION

* Indicates a required field

First Name:

 *

Last Name:

 *

Suffix:

Date of Birth:

Email Address:

 *

Address:

 *

City:

 *

State:

Zip Code:

 *

Day Phone:

Evening Phone:

Preferred contact method: 

  select e-Mail Day Phone Evening Phone

Membership:

  select Regular member $75.00 Associate member/Security guard/Citizen $75.00

                                                    Paid Membership:

Yearly Dues

Tell us more about your self:

Education:

  select High School Diploma Some College College Gradute Masters Degree Vocational School

Place of employment:

  select Newark PD Irvington PD East Orange PD Orange PD Union PD Belleville PD New Jersey State Police Federal Goverment West Orange PD other specify below *

Date of Application:

Title Rank:

  select Police officer Detective Sgt Lieutenant Captain Deputy Chief Chief Federal Agent Other specify below *

Additional requests or comments:

Mail check or money order to:        
New Jersey National Latino Peace Officers Association
7 Glenwood Ave. Suite 203
East Orange, New Jersey 07017      

We will respond to your e-mail within 24 hours. Your application will be processed when check or money order is received.

Thank you.