Membership Dues : NYPD Shomrim Society

Is this a new membership or a renewal?*

New Membership
Renewal

Membership Type*

MEMBERSHIP IS LIMITED TO ACTIVE, RETIRED, AUXILIARY, AND CIVILIAN 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*

Auxiliary Rank*

Shield Number

Retired: Date*

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)

I would like the monthly newseltter delivered by mail for $25.00 per year.

No
Yes

Newsletter is available free online at on this website. Call or email for password.

Optional Additional Donation

Payment Options*

Credit Card
ESS Direct Paycheck Deduction

ESS is only for active employees of the NYPD. After selecting this option please log on to ESS, proceed to Pay and Tax Information > Deduction Information > NYPD Fraternal Organization Dues > Enroll in Shomrim Society Inc, Once you have completed these steps you will see the deduction soon after in an upcoming paycheck. ESS is a one-time enrollment, dues will automatically deduct every year on the second paycheck in January. This will prevent any lapse in membership.

Total

$0.00

Credit Card

Card Details

Cardholder Name

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