Concerns of Police Survivors, DC Chapter

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ONLINE ENROLLMENT FORM

CURRENT MEMBERS: If you've recently changed any of your contact information (mailing address, phone, e-mail, etc.), please use the form below to send us the information so you don't miss out on any DC-COPS news and activities! If you are updating information, please also provide us with your old information so we are sure to remove it.

INTERESTED MEMBERS: You can also use this form if you'd like to sign up to be added to our database so that you can get our newsletters, event invitations, etc. We would love to have you as part of the DC-COPS family.

NOTE: Your information is kept confidential and we do not give it out NOR do we solicit over the phone. If anyone calls claiming to be from DC-COPS and looking for money, they do not represent our organization. Make every attempt to get as much information from the person as you can and let us know.

NEW or UPDATED INFORMATION:

First Name

Last Name

Street Address

City         State

Zip Code

E-mail Address

Primary Phone          Other Phone

How Did You Hear About Us?

Please let us know additional information: Are you a police survivor? If so please let us know the name of your officer, agenc, End-of-Watch date, and your relationship to the officer. Are you involved in law enforcement? Would you like to volunteer? What is your interest in DC-COPS? Thank you very much!

OLD INFORMATION
(Please fill out if you are updating your address, phone number, etc. You only need to fill out the older information that has changed.)

First Name

Last Name

Old Street Address

Old City         Old State

Old Zip Code

Old E-mail Address

Old Primary Phone

Other Phone

Is there any other information you'd like to update?

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Washington, D.C. Chapter, Concerns of Police Survivors, Inc.
Post Office Box 31549
Washington, D.C. 20030-1549
(202) 332-COPS
(202) 583-3505 fax
mail@dc-cops.org