Membership Application
Please print and mail, along with your dues to:
LACP
2855 I-10 Frontage Road
Port Allen, LA 70767
Phone (225) 387-3261
Fax (225) 387-3262
First member in department pays according to the following dues schedule. Each additional department member pays $100/each. |
Regular Member |
|
| 1 - 15 Officers | $100 |
| 16 - 30 Officers | $150 |
| 31 - 75 Officers | $200 |
| 76 - 150 Officers | $300 |
| Over 150 Officers | $500 |
| Retired Member | $ 50 |
Name______________________________________________________
Rank (only captain or above)_______________________________________
Department_________________________________________________
Address______________________City/State/Zip___________________
Email_______________________________________________________
Phone ( )_______________Fax ( )___________________
Elected or Appointed?__________________Civil Service?____________
# of Sworn Officers______________City Population_________________
Renewal or New Member?_____________________________________
Home Address_______________________________________________
Home Phone ( )___________Spouse's 1st name______________
Additional Member (s) ________________________________________
____________________________________________________________
____________________________________________________________