Retirement Badge Order Form
Last Name:
First Name:
MI:
Address:
City:
State:
Zip:
Phone:
IMPORTANT NOTICE: All badge orders must be accompanied by documented proof of retirement from a recognized law enforcement agency or military police unit. You must be a member of the Retired & Disabled Police of America to order this Badge.
Indicate the information as you want it to appear on your three-line nameplate.
Each Line can accommodate up to 20 characters including punctuation and spaces.
Top Line:
Middle Line:
Bottom Line:
State of Agency:
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