Welcome to Officer Down NJ

Officer Down, Membership Application

Thank you for your interest in membership with OfficerDown, NJ!

To become a member, fill out the form below.

Name:
Address:
City:
State:
Zip Code:
Phone:
Age:
Sex:
Email:

Are you a Law Enforcement Officer? Yes No
If Yes, Name of Dept/Agency
Address
City:
State:
Zip:
Rank:
Phone:

If you are not a Law Enforcement Officer
Occupation:
Business Address:
City:
State:
Zip:
Phone:
Email:

References: Officer Down requires three references of good character to ensure the integrity of potential members.
Reference 1
Name:
Phone:
Years Known:
Relationship:

Reference 2
Name:
Phone:
Years Known:
Relationship:

Reference 3
Name:
Phone:
Years Known:
Relationship:

In the space provided below, please tell us, in your own words, how you believe you could benefit Officer Down, Inc.

Thank you for you interest in becoming a member to Officer Down, Inc. You will be contacted before the next scheduled meeting. If you should have any questions, please feel free to contact me directly at (609-658-5572.

Respectfully,

Sean C. Lavin
Chairman

OfficerDown, NJ • P.O. Box 3281 • Mercerville, NJ 08619

Meetings are held the 1st Wednesday of the month @ 7:30pm at the Hamilton PBA.