6/28/2014  1:40:23 PM
  
ONLINE MEMBERSHIP APPLICATION
  
Applicants MUST provide a valid and unblocked email address on application form. Due to strict SPAM, virus, and email blocks that many agencies/employers are enforcing, please verify that you can receive incoming email messages from our listservers on your work email account, if you provided it to us. It is best to utilize a private, personal email account. If MARGIN emails get bounced or are rejected from your email account, you will be removed from the Members Only website until another email address can be provided.
 
  
Applicant Information
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Name: (Last, First, MI):
*
Home Mailing Address:
*
Date of Birth:
*
Home Phone Number:
*
Cellular Phone Number:
*
Email Address:
*
  
Applicant Employing Agency Information
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Agency Name:
*
Agency Address:
*
Agency Phone Number:
*
Title/Rank:
*
Supervisors Name::
*
  
Additional Applicant Information
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Check all that apply:
Active LEO: | Retired LEO: | New Member: | Renewal:
  
Additional Comments:
  
Upload copy of Law Enforcement Identification:
*
* Proof of Law Enforcement employment must be provided or this form will be void!
  
I certify that I am a Sworn Law Enforcement Official or Criminal Justice Professional in good standing:
Agree: | Disagree:
  
I am paying for my membership dues via:
PayPal: | Mailing Check: | Voucher: | Other: (If other please list details in comments box)
  
Applicant Members Only Information
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Username Email:
* Use a valid unblocked Email address
Password:
* Maxium eight (8) characters = numeric / alpha-numeric
Confirm Password:
*
  
I have read and agree to MARGIN Terms of Use:
Agree: | Disagree:
  
  
After submitting this form you will be taken to a confirmation and PayPal payment page.
If paying via check / money order your membership will not be active until payment is received.
  
security code
Enter Security Code: 

 
    
  
  
All applicant information is keep strictly confidential and will be used solely for membership identification and security purposes. MARGIN is a non-profit organization dedicated to the prevention and suppression of gangs and gang activity. By completing and submitting this application, the applicant agrees to adhere to the MARGIN By-Laws. Applicant attests that he/she is at least 18 years of age as of this date and a Sworn Law Enforcement Official or a Criminal Justice Professional. The MARGIN Executive Board reserves the right to refuse membership to anyone and/or to suspend any member for violating the MARGIN rules and By-Laws.
  
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