Jersey City Police Department
Emerald Society
Membership Application
Name_____________________________________ Rank____________
Address_________________________________________________
City_______________________ State _______ Zip______
Date of Birth __________________ Telephone (______) _________________
Department __________________________ District/Unit___________
Employer Address___________________________________________
How Long a Police Officer____________________________________
Signature_________________________ Date____________________
Dues are $30.00 per year. Make check payable to JC Emerald Society
Mail to: P.O. Box 351 Jersey City NJ 07303-0351