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| ASSOCIATE MEMBERSHIP APPLICATION |
| Illinois Police Reserves |
| Name _________________________________________ |
| Address _______________________________________ |
| City, State & Zip ______________________________________________ |
| Phone Number ( ) ___________________ |
| Fill in the following information and return it with a Check or Money Order in the amount of $15.00 Made payable to: Illinois Police Reserves Mail To: Sgt. Diego A. Figueroa Jr. Illinois Police Reserves Data Administrator 5908 W. School St. Chicago, Illinois 60634 |
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