To become a member, print this page and follow the directions.
Click
here when you are done
Home Address_________________________________________________________________________ Home Phone:___________Business Name/Address_____________________________________________ _____________________________________________________________________________________ Type of Business:__________________________________________Position:______________________ Are you an NYC Pistol Licensee?_____Pistol License #:____________________Type:__________________ 1) Have you ever been arrested? Yes____ No____ If so, please list all details and attach to this application. 2) Have you served in the armed forces? Yes____ No____ If so, give dates of service, and if discharge is other than honorable, explain fully and attach to appplication. 3) Are you now, or have you ever been a member of an organization that does not believe in or support the Constitution of the United States and the State of New York? Yes____ No____ 4) Has any license or permit issued to you or any business of which you are an officer, director, or partner ever been denied, revoked, cancelled, or suspended Yes____ No____ 5) Have you ever been confined for, or treated for, a nervous or mental disorder? Yes____ No____ 6) Have you ever used a controlled substance? Yes____ No____ 7) List three major organizations that you are currently a member of: a)____________________________b)_________________________c)_____________________ 8) State briefly why you want to become a member of the Police Reserve Association: _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ The following must be completed before an ID card can be issued: Social Security #_____-____-____ Weight_______Height_________Eye Color________ Drivers License#__________________State_______ List Three Personal References: Name,Address,Phone#__________________________________________________________ Name,Address,Phone#__________________________________________________________ Name,Address,Phone#__________________________________________________________ Do you affirm the truth and accuracy of the statements contained in this application? If so please initial here_______ Your E-mail address (if you have one):_________________________ It is understood that this application does not bind the Police Reserve Association unless and until the applicant is accepted for membership. Signature______________________________________Dated_______________ Note: First years dues of $250.00 must accompany this application. It will be refunded if the applicant is not accepted for membership. This application process may take up to four weeks. "Web Site Application" Return this application with your tax deductible check for $250.00 to: Police Reserve Association 244 Fifth Avenue New York, NY 10001 Please make check payable to: Police Reserve Association City of NY, Inc. |
