When you submit your online application, you will receive an email back in the email account you used to fill out the form confirming the information you submitted.   Please verify the information in the email and forward to the email address indicated in the email.

Last Name
First Name
Middle Initial
Address
City
State	Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip
Date of Birth (Example: 4/17/67)
Phone
E-Mail Address
Retired From
Date of Retirement
Date Submitted Example: 11/28/2021
Membership Type	Police  Fire   Associate    Honorary
	For Security - Please enter Code 08862

Police / Fire: Please send in annual dues ($25.00)

Option #1 Life Membership one time fee $125 and $10 annual per Capita

Option #2 Annual membership $35 per year this includes the per Capita. 

Associate and Honorary $100.00 yearly dues

Current Dues paying Members wanting to change to Life Members the open season change is available now
$100 if you have already paid your annual $25.00

Make checks payable to NJRPFA Local #9 and mail to:

    New Jersey Retired Policemen & Firemen's Association - Local 9
    PO Box 771
    Perth Amboy, NJ 08862

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