Membership Dues : NYPD Shomrim Society

Is this a new membership or a renewal?*

New Membership
Renewal
Honorary Membership Information Update
Public Relations Information Update

Date of Honorary Membership

WE ARE NOT TO BE CONFUSED WITH GROUPS THAT HAVE SIMILAR NAMES OR INTERESTS. PLEASE ENSURE YOU ARE AN HONORARY MEMBER. HONORARY MEMBERSHIP TO THE NYPD SHOMRIM SOCIETY IS BY NOMINATION ONLY AND NOT THROUGH APPLICATION. IF INTERESTED, PLEASE SPEAK TO A NYPD SHOMRIM SOCIETY MEMBER, BUT NOTE THIS IS NOT AN APPLICATION TO BECOME AN HONORARY MEMBER.

Membership Type*

MEMBERSHIP IS LIMITED TO ACTIVE, RETIRED, AUXILIARY, CIVILIAN MEMBERS AND LIFETIME MEMBERS OF THE NYPD. WE ARE NOT TO BE CONFUSED WITH GROUPS THAT HAVE SIMILAR NAME OR INTEREST. PLEASE ENSURE YOU FIT INTO ONE OF THESE CATEGORIES BEFORE SUBMITTING BEFORE FILLING OUT YOUR APPLICATION/RENEWAL.

Auxiliary Acknowledgement*

I agree

I hereby make application for membership in the Shomrim Society, Inc. of the New York City Police Department and acknowledge that I am of the Jewish faith and that I agree to the following guidelines: As an auxiliary member of the NYPD I agree to all benefits set forth by the constitution of the Shomrim Society, Inc. This is limited to membership benefits without burial and scholarship rights.

Are you reapplying after a lapse in prior Shomrim membership?*

Yes
No

When did you join?*

REINSTATEMENT*

I agree

If previous membership lapsed, I waive eligibility for burial rights until all back dues are paid at the prevailing rate, if eligible based on age. As for the scholarship program I waive eligibility until all back dues are paid at prevailing rate and there is a 5 year waiting period. In return, back dues will be waived by the society. I fully understand the above mentioned Reinstatement Clause, should it pertain to me, and I waive my eligibility rights as indicated in the clause. (By checking this box, you electronically indicate your acknowledgment in lieu of a physical signature)

Name*

First Middle Last

Email*

Mobile Phone*

Home Phone

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Command*

Civilian Title*

Rank*

Other Rank

Auxiliary Rank*

Shield Number

Date of Retirement*

Tax Number

Previous or Current Occupation

Date of Birth*

Gender*

Male
Female

Mothers Maiden Name

Date of Appointment*

MOS/NYPD Employee/ AUX Starting Date

Marital Status

Single
Married
Divorced

Spouse Name*

First Last

Spouse Date of Birth*

Spouse Religion*

Spouse Occupation*

Military Affiliation

None
Active Military
Retired Military

Branch of Service*

Service Start Date*

Service End Date*

Do you have children?

Yes
No

Children

Please enter children’s name, religion, and date of birth. This is not required.

Burial Rights*

I agree

I fully understand that my application for the NYPD Shomrim Society is contingent upon me being of the Jewish faith as described in the Death and Burial Benefits Section. (By checking this box, you electronically indicate your acknowledgment in lieu of a physical signature)

Optional Donation

Payment Type*

Credit Card
ESS

ESS is only for active and civilian employees of the NYPD. Complete this form and instructions will be emailed to you.

Total

$0.00

Credit Card

Card Details

Cardholder Name

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