Wisconsin Law Enforcement Officers Association
MEMBERSHIP APPLICATION
Fill out the application below and become a member of the
WLEOA,
the association dedicated to law enforcement -- our chosen
profession.
Name: ____________________________________________________
Street: ____________________________________________________
City: _________________________________ State: _______________
Zip Code: _____________________ Phone Number: ________________
County of Residence: ____________________ WLEOA District: _______
Department: _______________________ Length of Service: ___________
Full Time: Part Time:
Social Security Number: _____-_____-_____ Date of Birth: ____________
Applicant Signature:___________________________________________
Member Sponsor: ____________________________________________
Date: __________________________
Active $20.00 Associate $20.00 (includes $3.00 for annual magazine}
Make your check payable to the WLEOA.
Please Mail Completed Application to:
Wisconsin Law Enforcement Officers Association
Randy Albert - Secretary
7731 Co. Hwy. II
Hatley WI 54440
You may also e-mail Secretary Randy Albert at: rsalbert@mail.co.marathon.wi.us