Harrisburg

ACTIVE MEMBER

Signature HARRY MARNIE President 2022 Membership

Name ______________________________ Address ____________________________ City _________________ State __ Zip_____ Telephone # ________________________ Occupation _____________ Deduction ____ Sponsor ____________________________ EmailAddress _______________________

Philadelphia Emerald Society

FILL OUT THE ABOVE APPLICATION TO BECOME A MEMBER OF THE Philadelphia Emerald Society

Mail to: The Philadelphia Emerald Society P.O. Box 2430 Phila., PA 19147 DUES OPTION (check which) ______ ActivePolice/Firefighters ($15) ______ Pensioned Police/Firefighters (Payroll Deduction - $12) ______ Pensioned Police/Firefighters (Cash/Check - $15) ______ Civilian ($15)

If you choose the Pensioner Payroll Deduction, we will mail you a card to fill out or the Pension Board.