Membership Application

PoLEPFoR Membership Registration

Please complete this Application for Membership form as fully as possible.

Name

Email

Address

Suburb/Town/City

State

Country

Phone

Rotary Club (*)

Please record details of your Policing or Law Enforcement Service

Enter area of service e..g. Police, Customs, Military Police, etc (*)

Name of Agency (*)

Status

Rank

Currently Working (Working, Retired, Resigned)