Port Authority Retired Police Association

This is a private email list for members only (initially).
Please fill in all fields. This will help us confirm your identity, as well as allow us to communicate better with our membership.
None of the information is published in any way.

IMPORTANT
(Use the TAB key, or use your mouse to move to next field, (NOT the enter key)
then click SUBMIT at the Bottom).
If items are missing when you submit, they will be shown in RED (All Dates are entered mm/dd/yyyy,
All Days are entered mm/dd)
If you are retiring soon, enter your target date.

* indicates required

Email Address *

First Name *

MiddleInitial

Last Name *

Address

Street Address Address Line 2 City State/Prov/Region Postal/Zip Country

Please us 2 character state only, eg. FL NJ NY

D.O.B. *

Dues Free 75+

Birthday *

Month / Day

This is for Happy Birthday Messages

Retirement Date

This is for Verification Purposes. If you are retired YOU MUST FILL IN the 2 retirement fields (Day & Date)

Retirement Day

Month / Day

This is for Happy Anniversary Messages. If you checked "Working" in the Status filed, please change it.

Appointment Date *

Appointment Day *

Month / Day

This is for Anniversary Messages

Command *

From what command did you Retire

Unit / Detail

Cell Phone

Home Phone

Dues Year

DO NOT ENTER OR CHANGE ANYTHING IN THIS FIELD

State

Please add your 2 letter State Abbreviation (for sorting purposes)

Work Status

Still Working
Retired

Dues Payment Type

PayPal
Check