Fluent Form Test - Italian American Police Society

Gala Tickets

First Name

Last Name

Email

Shipping Address

Address Line 1

City

State

Zip Code

IAPSNJ Gala Dinner Dance - Add quantity -->

Price per Ticket $150.00

Quantity

If attending for an honoree, Who?

Please list All Names of attendees, as well as table seating requests.. If Mr & Mrs, please indicate in addition to full names so we may correctly print the placecards.

Choose Payment Method -

Pay with Credit Card (Stripe)

Offline Payment - See info at right.

My offline payment will be by

Venmo - Send to IAPS-Jersey in the App

PayPal use the link PayPal.me/iapsnj/ then add the amount.

Check - Mail to Ron Sepe. PO Box 258, Caldwell, NJ 07006

-Clear selection-

Gold Cards (3-2022)

First Name

Last Name

Member Type

Regular Member

Associate Member

Email - Use the email address on your PayPal account

Shipping Address

Address Line 1

City

State

Zip Code

We are not responsible for misspelled names. These are copied directly, and not re-typed

# of cards requested

Member Name - How you want it to appear on the card(s)

Bearer Name(s) - Please check spelling

Choose your Card Style

Single Logo Card - $12

Dual Logo Card - $15

Associate Member Card - $17

Department Name for second patch if desired. Either copy a link to the image here or upload photo.

Department Logo upload

Choose File

Payment Method - If you choose "Offline" you can pay later with Venmo. Send to IAPS-Jersey

Pay with Credit Card (Stripe)

Venmo "Offline" Payment

Application

Is This a Renewal for reactivation of your membership. If you have been away for 2 years or more, please fill out the application in it's entirety.

Yes

No

First Name

Middle initial

Last Name

Please add middle Initial, as we are seeing many more duplicate names, especially in law enforcement families.

Choose your Membership Type

LEO ($30/yr)

LEO Lifetime ($300 Retirees Only)

Associate ($50/yr) Please provide info below.

Address - (Please use proper capitalization for labeling purposes)

Address Line 1

City

State

Zip Code

Date of Birth

Referred By

Marital Status

Married

Single

Divorced

Spouse's Name

Work Status

Still Working

Retired

Retirement Date

Department (Include precinct, command, or special unit)

Rank

Email

Phone (Primary)

Phone (Home)

Explain your Ancestry