ASSOCIATION OF ROCHESTER POLICE
& AREA LAW ENFORCEMENT RETIREES, INC. Joseph C. Cimino – President William Connell – Executive Vice President Michael McCarthy – 1st Vice President John Rein – Vice President Blaise Dinardo – Secretary Richard Fantanza- Treasurer George Ehle – Sergeant at Arms A.R.P.A.L.E.R. APPLICATION REQUEST - PLEASE PRINT OR TYPE DATE_________________________ LAST NAME_______________________FIRST
NAME___________________MI____ CITY__________________________________STATE_________________ZIP_______ HOME PHONE____________ listed ( ) – unlisted ( ) WORK PHONE______________ YOUR DOB_______________ YOUR FORMER/CURRENT AGENCY_____________ DATE SWORN IN____________________RETIREMENT DATE__________________ OUT OF TOWN ADDRESS_____________________________________________________________- OUT OF TOWN PHONE NUMBER (_____)__________________ E-MAIL ADDRESS____________________________________________________ YOUR BENEFICIARY’S NAME___________________________________________ WE ARE A JOB RESOURCE CENTER, ARE YOU INTERESTED IN WORKING?______________ ____ PART TIME__________ FULL TIME__________ ARE YOU INTERESTED IN SERVING ON A COMMITTEE? YES_____ NO _______ MEMBERSHIP STATUS: ACTIVE___________ ASSOCIATE________________ PLEASE ENCLOSE YOUR CHECK FOR $20.00 MADE PAYABLE TO ARPALER. Richard Fantanza |