R.F.P.A. APPLICATION FOR MEMBERSHIP
DATE
LAST NAME
FIRST NAME
MIDDLE INITIAL
SPOUSE FIRST NAME
MAILING ADDRESS
CITY
STATE
ZIP CODE
HOME PHONE
CELL PHONE
E-MAIL ADDRESS
LAST 4 / SOCIAL SECURITY #
AGENCY
POLICE
FIRE
NEWSLETTER PREFERANCE
READ ON WEBSITE
MAILED
STATUS
RETIRED / NO LONGER WORKING
DROP / STILL WORKING
DATE RETIRED