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ADDITIONAL MEMBER/ AGENCY INFORMATION:

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PAYMENT INFORMATION:

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Signature
Endorsement*

*Membership endorsements will be obtained by FPCA Staff.  Please print the completed form and mail or fax to:  Florida Police Chief's Association, Membership Department, P.O. Box 14038, Tallahassee, FL 32317-4038,   FAX# 850-219-3640.