Type of Membership :
2016
(Address for Application Dues Only)
P.O Box 564071, College Point, NY 11356

Check or Money Order Only
 
 
 
Name :         Last Name         Middle Name hereby apply for membership in the Hispanic Society, Police Department, City of New York, Inc. I understand the $35.00, which is payment for ONE YEAR DUES, will be returned if this application is not accepted at the next Executive Board Meeting.

 
Rank  
Command  
Command Phone #  
 Shield#  
Tax#  
Date of Appointment  
City  
Zip  
EMAIL  
State  
       
 Apt/PH  
Home#  
Cellphone#  
 D.O.B  
Gender :
Heritage  
 
           
Dependants: (Please include age)
1- 2-
3- 4-
(Additional dependants may be added on the back of this application)
           
Date
   
     
       
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If you have any question, please contact us at : 212-252-4645
www.nypdhs.com