CopsWivesTM Application For Membership

Name of Applicant (please print):†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††
I certify that this is my legal name, as shown on my driver's license or other state-issued identification card. I agree to abide by the rules of CopsWives(tm). I know that when rules change I have the right to follow the new rules or leave the group.

†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††
Applicant's Signature††/††E-mail Address††/††Date


Name of Applicant's Husband (please print):††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††
I certify that this is my legal name, as shown on my driver's license or other state-issued identification card. I also certify that I am a police officer or some other form of law enforcement officer.

†††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††
Applicant's Husband's Signature††/††Date


NOTARY STATEMENT:††Before me, ††††††††††††††††††††††††††††††††††††††††††††††††† presented her valid driver's license or other state- issued identification card for proof of identity. Also before me, ††††††††††††††††††††††††††††††††††††††††††††††††† presented his valid driver's license or other state-issued identification card for proof of identity. He also presented proof of being a law enforcement officer. He presented his badge PLUS one of the following:

A badge alone is NOT proof!
††††††††††††State-issued peace officer "license" / identification card.
††††††††††††Police Department issued identification which states that he is a law enforcement officer.

SWORN TO AND SUBSCRIBED BEFORE ME this †††††††††† day of †††††††††††††††††††††††††††††, 200__.
Notary Seal graphicGiven under my hand and seal of office:






††††††††††††††††††††††††††††††††††††††††††††††††††††††††††††
Signature of Notary Public

Mail completed application to:††CopsWives, PO Box 251, Columbia, TN 38402.

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