If you wish to renew your membership with the PGPD RETIREES ASSOCIATION, Print, fill out this application and mail it to the address on the form.

If you have ANY questions about this, call: Toni Frostbutter: (240)472-2584 or pgretiredassn@aol.com

Only dues current members receive the newsletter.

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LastName:_____________________ FirstName:____________________ M.I.________

Street: _________________________________ Phone Number ( ) ______________

City:________________________ State:_______________ Zip:____________________

Date of retirement: ______________ ID#_________ Type of retirement:_____________

Spouse’s name: __________________ Dues exemption: Yes____ No____ D.O.B.______________

New occupation or pastime (for newsletter purpose): _____________________________

_______________________________________________________________________

E-mail address: __________________________________________________________

* (Retirees 65 years of age or older are exempt from dues payments- However, you MUST return this form

Please fill out the above form and submit a $25 Check, payable to the: P.G. RETIRED POLICE ASSOCIATION,
mail Form & Check to:

P.G. RETIRED POLICE ASSOCIATION
P.O. BOX 510
Lothian Md. 20711
OR, BRING IT WITH YOU TO THE NEXT MEETING (1st Wed. of each month)





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Last updated: 2/16/12