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Suffolk
Police Officers’ Association
Local
#5022
P.
O. Box 3369
Suffolk, Virginia 23439-3369
APPLICATION
FOR MEMBERSHIP
1. I, the undersigned, hereby apply for membership in and designate
the Suffolk Police Officers’ Association, Local 5022, AFL-CIO, as my duly authorized representative on matters relating
to my economic welfare, including wages, hours, working conditions and, as my representative in FLSA matters and in grievances
I may have concerning these matters.
2. I, the undersigned, have read, understand, and will adhere to the
Constitution and By-Laws of the Suffolk Police Officers’ Association, Local 5022. I also understand that I must maintain
good standing with the Association as defined in the By-Laws.
3. I, the undersigned, affirm that I have no pending departmental
disciplinary action or job related legal action, (criminal or civil), that would require the services of the legal counsel
retained by the Suffolk Police Officers’ Association, Local 5022.
4 I, the undersigned, will be solely
responsible for notifying the Treasurer of my intent to terminate my membership and stop my dues in writing and signed. Verbal notification will not be accepted. If the member does not notify the Treasurer
and stop their dues from withdrawal, SPOA will not reimburse the member for dues that continue after membership termination
or separation from employment.
Please
Print:
Name: ______________________________________________
rank:________________________________________________
Address:_____________________________________________
Home Phone: ________________________ Cell: ___________________________
PLEASE INCLUDE E MAIL ADDRESS: __________________________________________________
**SEE TREASURE (Beth Gayle) for WITHDRAWAL SLIP for PAYMENT OF DUES**
Date: ________ Signature: _____________________________________
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