2024 current member data form

2024 member data form-dues $30

Pay your Dues & Xmas pty=$60
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Mobile Number*
DOB*
11/17/55
DOA*
11/17/55
DOR (if applicable)
11/17/55
Rank or Title*
Correction Officer or ?
Shield or ID #*
Correction Officer or ?
Command*
eg: AMKC or Retired
Membership type*

Irish Heritage Active/Retired MOSIrish Heritage Active/Retired CivilianIrish Spirit Active/Retired MOSIrish Spirit Active/Retired Civilian
Please select one*

2024 dues only $302024 dues and Christmas Party $60
Payment Method*

Check payable-NYCD Emerald Society IncZelle payment-info@nycdemeraldsociety.orgPayPal-PayPal.me/nycdemeraldsinc $32 for dues or $64 for Dues and Partycredit/debit cards-plus convenience feeApple Pay-plus convenience feeCash App-plus convenience fee
Mail Check Payable

NYCD Emerald Society Inc.

PO Box 38

AB, NY 11509

Zelle Payment

info@nycdemeraldsociety.org

NYCD EMERALD SOCIETY INC

*Skip the next section. Submit*

PayPal Payment

Follow link to

PayPal.me/nycdemeraldsinc

$32 (dues) or $64 (dues & xmas pty)

NYCD EMERALD SOCIETY INC

*Skip the next section. Submit*

Credit/Debit Cards, Apple Pay, and Cash App

convenience fees applied

*Complete the next section, then press submit

Credit/Debit Apple Pay & Cash app-*Make sure you press the submit button*

2024 dues Donation

$32.00

24 Dues & Xmas PartyDonation

$64.00

Total

$0.00

Credit Card

Apple Pay

Cash App Pay

2024 member data form-dues $30