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Emerald Society Member ID# ______________ (PLEASE CHECK YOUR ID CARD OR NEWSLETTER MAILING LABEL) |
| Name: Last _________________________________________________________________________ |
| First ____________________________________ |
| Address __________________________________________________________ Apt # ____________ |
| City, State, Zip _______________________________________________________________________ |
| E-Mail Address ______________________________________________________________________ |
| Home Phone:______________________________ Work Phone: ____________________________ |
| Department/Unit______________________________________________________________________ |
| CHECK ONE | |
| Probationary Police Officer (Less than 18 months on job): | _______ Free |
| Police Officer (Over 18 months on job, First Time Member): | _______ $15.00 |
| Retired Officer (still must renew yearly): | _______ Free |
| Retired Officer, please accept my donation of: | _______ |
| Renewal: | _______ $30.00 |
| Associate: | _______ $30.00 |
Address Change or Correction:
| Old Address: ___________________________________________________________________ |
| New Address: __________________________________________________________________ |
_______ I would like to receive my correspondence when possible (including newsletters) by E-Mail.
I understand that it is my responsibility to update my e-mail address by sending the information to:
Please remit check payable to: Emerald Society of Illinois, P.O. Box 557819, Chicago, IL 60655-7819
Please fill out completely and legibly so you are sure to receive newsletters. Please check the label on newsletters for errors. If you are current and there is a need for change please email to the address above or contact Jim McCarthy at the above P.O. Box, or by telephone at 847-336-6939.
(updated 12/04/2009)