The following form is for use by OPBA members retiring from service to receive items which are listed out in the membership packet.
RETIREMENT ITEMS SHOULD BE MAILED TO YOU WITHIN 3 MONTHS FROM OUR RECEIPT OF THIS FORM.
First Name:
Middle Initial:
Last Name:
Position:
Department:
Badge Number (if applicable):
Mailing Address:
Phone Number:
Email:
Retirement Date:
Years of Service (including bought military and other dept.)
Do you want to have a picture for the Police Beat Magazine?
YesNo
Do you want to remain an OPBA member?
