MILWAUKEE  RETIRED POLICE ASSOCIATION

                                           2010 MEMBERSHIP APPLICATION

                                                         RENEWABLE  EVERY JANUARY 1st

         NEW: _____    RENEWAL:_____ DUES: $ 5.00         DONATION  $ ________

Name:  Last:____________________________________ First: _________________________

Address:___________________________________________________________Apt.#____                                                                                             

City:____________________________________  State:  _____     Zip Code:  _________

DOB__________________ Age ______

Phone #______________________Listed____Unlisted_____

E-Mail       ___________________________________   List it on website ?  Yes ____ No __

Spouse: ___________________Deceased: _____Wedding Anniversary Date_________________ 

SNOWBIRDS: List winter address:__________________________________________________________

  And what months you’ll be there:  ____________________________________________________________

  Completed 25 years of  service with The Milwaukee P.D. 

In Year__________Retired In Year__________                                                                                                                                              

                              MAIL TO:    MILWAUKEE  RETIRED   POLICE   ASSOCIATION                             

                                                                                    P.O. Box 340877

                                                                           Milwaukee, WI 53234-0877

                  Print this application out and mail it along with your dues to the above address.