Type of Membership Associate MembershipActive MembershipActive Membership w/ Legal Defense Personal Information First Name * Middle Last Name * Street Address * Address Line 2 City * State * ZIP Code * Phone * Personal Email * Date of Birth * Sex * MaleFemale Upload LE Credentials * Employment Information Employer * How long have you worked there? * Duty Title Division Employer Address Street Address Address Line 2 City State ZIP Code Payment Information Dues Plan * Membership Dues Only - $4.25/moMembership + Legal Defense - $25.85/mo Payment Method * CheckCashBank Draft (+$0.28 monthly fee) Bank Draft Authorization Name of Bank * Routing Transit Number * Account Number * Draft From * CheckingSavings Date to Start Draft * Upload Voided Check * Authorization * I authorize my account to be drafted as stated and will maintain sufficient funds. I agree to indemnify the Lodge and bank against overdraft losses. Legal Defense Plan Application SSN (last 4) * Lodge Number * Payment Arrangement * Participate in bank draftOther payment option (annual) Legal Defense Authorization * I agree drafts (if used) will match the current payment to the SC FOP Legal Defense Plan and indemnify the SC FOP and bank for any overdraft losses. Date * Signature * Clear Certification * I certify the information provided is true and correct. Δ
