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If my membership shall be revoked I hereby agree to return the auto emblem and all membership cards. Dues are 100. 00 and 175. 00 with shield and holder. A copy of active/retired dept. ID submitted with application and vehicle registration. Signature NAME ADDRESS BIRTHDATE Date HOME PHONE CELL PHONE TOWN ZIP CODE LICENCE PLATE STATE OF LICENCE PLATE INSTITUITION/UNIT/DEPT. NEW JERSEY LAW ENFORCEMENT OFFICERS LODGE NO. 169 FRATERNAL ORDER OF POLICE WWW.NJLE169. ORG foplodge169 aol.com 83...
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