Police and Fire Emerald Society of Nevada, Inc.
Membership Application

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Name _______________________________________________________________________________
                    First                                                                    Mi                                               Last

Address______________________________________________________________________________
                  Number                                                                 Street                                          Apt#

          _______________________________________________________________________________
                   City                                                                        State                                           Zip

TO THE OFFICERS OF THE POLICE AND FIRE EMERALD SOCIETY OF NEVADA, INC: I, the undersigned do hereby attest to be of Gaelic descent or have the Irish spirit, and make application for membership in the Police and Fire Emerald Society of Nevada, Inc. Further, it is understood that acceptance in the Police and Fire Emerald Society of Nevada, Inc. does not in any way protect the member against violations of the law, nor has the member been promised any favors or immunity by any law enforcement officer. I proclaim to be of good character and a law abiding citizen of the United States. Board of directors may request verification of the type of membership a person is applying for.

Type of Membership: Active ___ Associate ___ Auxiliary ___ Honorary ___ Other ___

Type of Agency: Police ___ Fire ___      Status: Active ___ Retired ___ Civilian ___ Other ___

Birthdate _________ Home/Work Phone __________________ Email __________________________

Organization/Rank __________________________

Signature ________________________________           Date _________________________

Beneficiary Name __________________________          Relationship ___________________

Address _________________________________          Phone ________________________

MEMBERSHIP YEAR COMMENCES JANUARY ANNUALLY
ANNUAL DUES: $25 (Active/Associate/Auxiliary)
LIFETIME MEMBERSHIP $250
Make Checks Payable to:
Police and Fire Emerald Society of Nevada, Inc.

SEND COMPLETED APPLICATIONS TO:
Police and Fire Emerald Society of Nevada, Inc.
P.O. Box 94901
Las Vegas, NV 89193-4901
Phone: (702) 644-7337
Fax (702) 361-9904
Email: pfesofnv@cox.net