Join | NY Women in Correction

If you prefer to not register online click here to print out the application and return it to us with your payment.

Name*

First Last

Email*

Address*

Street Address Address Line 2 City State ZIP Code

Home Phone

Cell Phone

Shield

Facility

Rank

Date of Appointment

Beneficiary*

First Last

Agency

Are you Uniform or Non-Uniform?*

Please check which committees you would like to serve on:*

Are you retired?*

Is this a new membership or renewal?*

Active/Non-Uniform Membership Fee

Price:

Retiree Membership Fee

Price:

Add additional $5.00 if you wish to donate toward Scholarship Fund*

Total

$0.00

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