Stone City Lodge #94 Fraternal Order of Police Active $36 (Police Only)  /  Associate $25 Member Application Name: ___________________________________________________________________ Address:__________________________________________________________________ Age: _____      Date of Birth: ____/____/____    Phone Number:  (_____) _____-_______ Occupation: _______________________________________________________________ How long have you been a resident of Lawrence County? __________________________ List any arrests, including Traffic Citations: _____________________________________ _________________________________________________________________________ Date of Application: _____/_____/_____ This is to certify that I have completed the above application and that the above information is true and correct to the best of my knowledge.  I agree to abide by the Constitution and By-Laws of the Stone City Lodge F.O.P. #94 and should my membership be revoked, I shall return to the Secretary the emblems and membership card that was furnished to me by the lodge. Applicant's Signature: ______________________________________________________ Recommended by: _________________________________________________________ Note: Any application that is not filled out completely and in detail by the applicant cannot be accepted for proposal by the lodge. Please make checks payable to Stone City Lodge #94 F.O.P. and mail your application form to: Stone City Lodge #94 F.O.P. P.O. Box 52 Bedford, IN 47421