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NRLO MEMBERSHIP
FORM
See Benefits for details on Memberships and
newly added Benefits
Print this page and mail
to: NRLO P.O. Box 6505 San Antonio,
Texas 78209
or Contact NRLO for Group Rate and/or
Membership/Information Forms and say how many you
require.
NRLO Premium Membership - $45
yearly*
Please check and
fill in all blanks that
apply: DATE
of application:
1 NEW MEMBER 1 RENEWAL
MEMBER #: 1 $45 Yearly Individual
Dues 1 Additional Forms
Needed_____
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LAST
NAME:
FIRST/MIDDLE:
D.O.B.
(YY/MM/DD):
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MAIL
ADDRESS:
CITY:
STATE:
ZIP:
**************************************************************************************************************************************************************************
TITLE/RANK:
1Reserve 1Auxiliary 1Regular 1Other: Date
Sworn(YY/MM):
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HOME
PHONE: (
)
WORK PHONE: (
)
DEPARTMENT PHONE: (
)
**************************************************************************************************************************************************************************
PERSONAL
E-MAIL:
BUS.
E-MAIL:
FAX:
(
)
1Personal1Business
**************************************************************************************************************************************************************************
Full-time Job Description (if you are a
Reserve):
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Department:
Name of 1 Sheriff 1
Chief of Police 1
Other:
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Dept./
Address/City/Zip:
#Reserves:
#Regulars:
**************************************************************************************************************************************************************************
Unit
Leader Title: 1Coord.1Liaison1Cmdr.1Pres.1Chief1Other: Name:
1Res. 1Reg.
**************************************************************************************************************************************************************************
TRAINING:
Total Hrs.: Basic
Hrs.: Intermediate
Hrs.: Advanced
Hrs.: In-House Training
Hrs.:
/(Wk)(Mo)(Yr) Other:
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Comments
on
Training:
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AUTHORITY/COMMISSION which qualifies and
certifies
Reserves:
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NOTE: Beneficiary names and addresses
must be on file in NRLO's Computer Records; please supply
information
below:
INSURANCE BENEFICIARY
NAME:
RELATIONSHIP TO
INSURED:
**************************************************************************************************************************************************************************
BENEFICIARY
ADDRESS/CITY/STATE/ZIP:
PHONE: (
)
**************************************************************************************************************************************************************************
REMARKS/
(Examples: "How Often and Where your Unit meets" or "Comment from
Dept. Leader" or "Brief Summary on your Law
Career):
* Dues are
non-refundable
**************************************************************************************************************************************************************************
Insurance coverage effective on receipt of
payment.
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