Surprise Police Employees Association

Membership Application Form

_____________________________________________________________________________
Last Name First Name M.I.

_____________________________________________________________________________
Home Address City/State Zip

_____________________________________________________________________________
Home Telephone Cellular

_____________________________________________________________________________
Personal E-mail Address

_______________________________________
Social Security Number

______________________________________________________________________________
Signature Position

SPEA Office use only. Do not write below this line.

Date enrolled:____________________________________

Payroll deduction form signed: Y / N

President Signature:_______________________________

Date:___________________________________________