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, 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?*
MM slash DD slash YYYY
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*
MM slash DD slash YYYY
Tax Number
Previous or Current Occupation
Date of Birth*
MM slash DD slash YYYY
Gender*
- Male
- Female
Mothers Maiden Name
Date of Appointment*
MM slash DD slash YYYY

MOS/NYPD Employee/ AUX Starting Date
Marital Status
- Single
- Married
- Divorced
Spouse Name*
First Last
Spouse Date of Birth*
MM slash DD slash YYYY
Spouse Religion*
Spouse Occupation*
Military Affiliation
- None
- Active Military
- Retired Military
Branch of Service*
Service Start Date*
MM slash DD slash YYYY
Service End Date*
MM slash DD slash YYYY
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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