MEMBER APPLICATION $42.00 monthly

NEVADA PEACE OFFICER ASSOCIATION
145 Panama Street, Henderson NV 89015 (702) 813-7409

Applicant's Name:
NEATS Number:
Last 4 SSN:
Agency:
Date of Hire:
Title:
Grade/Rank:
Sex:
Marital Status:
DOB:
Work Address:
City, State:	, AKALARASAZCACOCTDCDEFLGAGUHIIAIDILINKSKYLAMAMDMEMHMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPAPRRISCSDTNTXUTVAVIVTWAWIWVWY
Zip Code:
Residence Mailing Address:
City, State:	, AKALARASAZCACOCTDCDEFLGAGUHIIAIDILINKSKYLAMAMDMEMHMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPAPRRISCSDTNTXUTVAVIVTWAWIWVWY
Zip Code:
Cell Phone:
Home Phone:
Work Phone:
Home Email Address (*PREFERRED*):
Work Email Address:
I recognize that the NEVADA PEACE OFFICER ASSOCIATION is not affiliated with my employer and/or the State of Nevada.
Applicant's Signature:
Date of Application:
Referred By:
By submitting, I hereby designate the Nevada Peace Officer Association and Nevada Association of Public Safety Officers as my exclusive collective bargaining representative, to represent me in all matters pertaining to my employment with the State of Nevada, and to assert my rights under all contracts, policies, procedures and laws within their discretion.