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Kansas State At-Large Lodge #55 Application

APPLICATION

Membership to State At-Large Lodge 55

Fill out the form below in its entirety and click the "Submit Application" button at the bottom. You will then be given a link to pay your initial $100 dues online via Cashapp. Once you have been informed that your application is accepted and you are enrolled in the Grand Lodge of the Fraternal Order of Police's rolls, you will then need to enroll in the FOP Legal Defense Plan.

It is suggested NOT to use your work e-mail as your e-mail address. Work e-mails are searchable without a warrant.

If any information changes, it is incumbent on the member to keep the Kansas State Lodge updated with your information.

Note: The FOP maintains this information in-house and will not sell, distribute or give your information to any other organization.

Place your initials before each statement:

1. I am a Kansas certified or Federal full-time or elected law enforcement officer and/or qualify for membership as outlined by the Kansas State Lodge Constitution and By-Laws.

2. There are no other FOP lodges available for membership in my immediate jurisdiction.

3. I understand that as a member of the At Large Lodge, enrollment in the FOP Legal Defense Plan is mandatory to be a member of the At Large Lodge. I understand it is my financial responsibility to maintain membership with the FOP Legal Defense Plan as a condition of my membership, unless I have been given an exemption by the State Executive Board.

4. I understand that annual membership is due on January 1 of every year and I will be responsible for renewing my membership. (The State FOP Lodge will post announcements and send reminder e-mails. If your e-mail address changes without notifying the State FOP Lodge, you may not receive membership renewal information.)

First Name:

Last Name:

Middle Initial:

Address:

City, State:

ZIP Code:

Personal Phone:

Personal E-Mail Address:

Date of Birth (DD/MM/YYYY):

Male/Female:

Primary Agency:

Agency Address:

City, State:

ZIP Code:

Agency Phone:

Signature:

By typing your name above, you attest that all the above is true and accurate.

Enter the text shown in the image above.