Highway Patrol Association

APPLICATION FOR MEMBERSHIP

62^nd MP [Highway Patrol] Company Association

Last Name:___________________________________ First Name:_________________________ MI: _______

Address: ________________________________________________________________________

City: _________________________________________  State: _________   Zip-Code: ____________-_______

Telephone Number: (____)_____-________      E-mail address:  ___________________________________

Assigned to HP Unit/Det. ___________________________________________________________________

Location:_____________________________________________________________________________

I served with the unit from; ____________________ Until; __________________________    Rank while in unit: _________________

                                                Month/Day/Year                               Month/Day/Year

Are you interested in attending a reunion?   Yes: ______  No: ______

Do you have an arm brassard?  Yes:______ No: ______         Do you have Unit Crest? Yes:_____ No: ____

Please list all other members with whom you served, or know.   Please include any address, telephone numbers and all other information which you may have about the unit, or personnel once assigned.  Please use additional sheets of paper if necessary.