NEW YORK 1013
 260-09 Hillside Avenue
Floral Park, N.Y. 11004
Phone: 718-343-7271
Fax: 718-343-1852

 

 

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When you complete this application, print out 2 copies. Keep one copy for your records and send the other copy along with the $15.00 in dues to the following address:

NY 10-13 Association
260-09 Hillside Avenue
Floral Park, NY 11004

MEMBER APPLICATION

First Name  
Middle Initial  
Last Name  
Street Address  
City  
State  
Zip Code  
Home Phone  
Other Phone  
Email  
Date of Birth  
Last Command  
Date Appointed  
Date Retired  
Retirement Service (Service Completion, 3/4s, Ordinary Disability, Other)  
New Member or Renewal