AURORA POLICE RETIRED OFFICERS ASSOCIATION, INC.

APPLICATION FOR MEMBERSHIP

Membership type being applied for:      Active      Associate

Applicant Name:   _________________________________________________________________
 
If applying as a widow/er, your spouse's name: __________________________________________________________
 
Address:   ________________________________________________________________________
	(Street address, City, State, Zip)

Telephone   Landline: ________________________  Mobile/text: ___________________________

Email address (Please print clearly):  ___________________________________________________

Your (or your spouse’s) date of hire or service years at A.P.D. ______________________________

APD Academy class number: ____________    Date of separation  ___________________________
 
Type of separation:    retired      medical      resigned       other: ________________________

Current/previous rank/position: _______________________________________________________  

Associate applicant: Other/previous/elsewhere service : ___________________________________
_________________________________________________________________________________
_________________________________________________________________________________
 
Pro-rated Dues Payment Schedule for NEW applicants, if you first join in:
Jan.     Feb.     Mar.     Apr.     May     June     July     Aug.     Sept.     Oct.     Nov.     Dec.
$60     $55      $50       $45      $40       $35      $30      $25       $20      $15      $10        $ 5

Dues Paid  $ ________   Date paid:  __________________     Check   other: _________________

  Please check if paying through PayPal to treasurer@aproa.net (easy link at APROA.net)

PayPal dues were sent from email:  same as above   or: __________________________________

Arrange any other payment method with the treasurer via email, at treasurer@aproa.net

scan and email this application to secretary@aproa.net, or mail printed application to: 
APROA, P.O. Box 473421, Aurora, CO 80047-3421
(Please make check payable to APROA)

Office use only:  Board member receiving application: ____________  Dues verified: ___________
Notes: ___________________________________________________________________________