Assoc Losses Form
| 
| Hits: 7868
FRATERNAL ORDER OF POLICE
STATE LODGE OF MICHIGAN
ASSOCIATE MEMBERSHIP FORM -- LOSSES
REASONS: TO=Transfer Out DUP=Duplicate D=Deceased I=Inactive RES=Resigned
***********PLEASE PRINT CLEARLY***********
|
NAME
|
REASON |
|
NAME
|
REASON |
|
NAME
|
REASON |
|
NAME
|
REASON |
|
NAME
|
REASON |
|
NAME
|
REASON |
|
NAME
|
REASON |
|
NAME
|
REASON |
|
NAME
|
REASON |
|
NAME
|
REASON |
|
NAME
|
REASON |
|
NAME
|
REASON |
|
NAME
|
REASON |
LODGE # ______ DATE: _____ SECRETARY: ___________________________