EmailMe Form - AAPOL Member Contact Form

Date Time *

MM / DD / YYYY

Name *

First Last

Payroll # *

Membership Status *

Current Rank *

PERSONAL email (not city) *

Cell Phone *

### - ### - ####

Current Assignment/Division
If patrol, list your station.
If concerned division, list your division name and role. *

Work Hours *

Day Shift (0600-16000)

Evening Shift (1300-2300)

Night Shift (2100-0600)

Do you currently receive organizational updates via email? *

If you are not inside of the organization's GroupMe, would you like to be added? *

Would you like more information about joining a committee or becoming a station steward? *

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Comments

I confirm that the contact information above is current and accurate.
(Your confirmation consents to AAPOL sending you correspondence via email, text, or phone) *

I confirm.