Glendale Law Enforcement Association, Glendale Police, Glendale Law Enforcement

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JOIN GLEA

GLEA membership is available to sworn law enforcement officers employed by the City of Glendale.

Use the form below to join GLEA.

The process is simple and secure. Your information is fully secured using GeoTrustTM 128-bit SSL encryption technology.

Please note: Once you have submitted your application, you will be contacted by a board member to sign your beneficiary designation form, as well as payroll deduction form. At that time you will also need to pre-pay for your first month's dues ($25). Please make your check payable to Glendale Law Enforcement Association.

* Indicates a required field

Name *	Serial # *
Address *

City *
State *	Zip *
Telephone * (623-123-4567)	Pager or cell # *
Date of hire *(mm/yy)	Date of birth *(mm/dd/yy)
SSN * (123456789)	Preferred email address: *
Insurance Beneficiary Information
This portion is not required, but please complete it if you have elected your beneficiary.
Beneficiary name	Relationship
Address
Address Line 2
City
State	Zip
DOB (mm/dd/yy)	Telephone (623-123-4567)

Any comments or questions?
All information provided is strictly private and will not be disseminated or used in any manner other than to enroll officers in our membership plans.

The Glendale Law Enforcement Association
PO Box 5631
Glendale, Arizona 85312-5631

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