(please print this out)

PETITION FOR INITIATION AND MEMBERSHIP

Fraternal Order of Police Associates of Ohio, Inc. Glenn Kruger Portage Number 9

________________________________ _____________________ ___________

Print – Name in Full Birth Place Birth Date

________________________________ ___________ __________________________

Residence - City Zip Code Phone Number

email address: ___________________________

_________________________________ ___________ __________________________

Business Address Zone No. Phone Number

__________________________________ send mail to: check one / / Residence

Profession or Occupation / / Business

Name of Business or Firm:____________________________________________________

I, _____________________________,the undersigned, hereby make application to join this Lodge, of the Fraternal Order of Police Associates of Ohio, Inc., and hereby state that I am more than 18 years of age, and a citizen of the United States of America. I hereby state that I am of good repute and have never been convicted of a felony and never have been a member of any subversive or un-American organization. I. AGREE, if found qualified to abide by the rules, laws, regulations, etc., of the Lodge, and the DECAL, MEMBERSHIP CARD, METAL EMBLEM, ETC., are the property of the Lodge and can be recalled by the Lodge of this order for misuse or non-payment of dues, or other valid reasons.

Herewith, I enclose my check, or money order for $_________________to cover initiation fee and dues for one year.

Social Security No. _________________________Signature of applicant:________________________

Recommended and Vouched for on the honor of:

Brother/Sister ___________________________________( ) FOPA ( ) FOP

Print Signature ______________________________

Signature

Brother/Sister___________________________________( ) FOPA ( ) FOP

Print Signature

______________________________

Signature

F.O.P.A. F.O.P.

( )APPROVED ( ) DISAPPROVED ( ) APPROVED ( ) DISAPPROVED ( )

_____________________________________ __________________________________

Signed Signed

Date:__________________________________ Date:____________________________

Fee Received: __________________Initiated on _______________Elected on:____________

To Whom It May Concern:

I hereby give any law enforcement agency or organization the authority to investigate or furnish information concerning me as may be required by _________________________________, without recourse, for consideration of application to become a member. This will be held confidential.

Signed ________________________________________ dated: __________________

Witness________________________________________ dated___________________

PRESIDENT SAYS:

RAISE YOUR RIGHT HAND, PLACE YOUR LEFT HAND OVER YOUR HEART, AND REPEAT AFTER ME:

OATH FOR NEW MEMBERS

I,_____________________________, in the presence of Almighty God and before the

Members here assembled,--- promise to abide by,--- and obey all laws, rules and regulations,---- and an obedience to the Constitution, --State and Ravenna Lodge Number 9 --- of the Fraternal Order of Police Associates.—I promise to defend the Principles and purposes of the Lodge --- and to recognize and accept all decisions, -- of the legally elected officers of this Lodge, -- Providing they do not conflict – with my religious or political views, --or my rights as an American Citizen. ---I will always cherish the Emblem of this Lodge, -- and the principles for which it stands, --and if after careful consideration – by this Lodge, ---I have been found unworthy of membership, -- I will willingly --- surrender my Dues Card and Emblem.

To all of this --- I pledge my sacred honor !!

___________________________________ ____________

Signature Date

__________________________________ ___________

Witness Date