Honorary Annual Membership – NYS FOP LODGE 44

Welcome to NYS FOP LODGE 44,

The Member Renewal starts from October to December for the following year.

Name:*

First Name Required Last Name Required

Address Line 1:* Address Line 1 is Required

Address Line 2: Address Line 2 is not valid

City:* City is Required

Country:* Country is Required

State/Province:* State/Province is Required

Zip/Postal Code:* Zip/Postal Code is Required

Cell Phone:* Cell Phone is Required

Date of Birth:* Date of Birth is Required

Agency:* Agency is Required

Position:* Position is Required

Date of Appointment:* Date of Appointment is Required

Name of the Survivor Benefit:* Name of the Survivor Benefit is Required

Street Address of the Survivor :* Street Address of the Survivor is Required

City of the Survivor:* City of the Survivor is Required

State of the Survivor :* State of the Survivor is Required

Zip Code of the Survivor:* Zip Code of the Survivor is Required

Survivor Relationship: Survivor Relationship is not valid

Telephone of the Survivor :* Telephone of the Survivor is Required

Email:* Email is Required

Email:* Invalid Email

Password:* Invalid Password

Password Confirmation:* Password Confirmation Doesn't Match

Password Strength

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$75

	Honorary Annual Membership – Payment $75	$75.00
	Total	$75.00

Honorary Annual Membership – Payment

$75

$75.00

Total

$75.00