2012  CLUB  DUES  WERE DUE BY JAN 31, 2012
   Your 2012 dues are now due.  continue the club benefits & continue receiving the newsletter.

Member's Name___________________________________    Spouse's  Name______________________________
Pension # (Include all letters & numbers)______________________________________________________________________________________

Address_______________________________________________________________________________________

Tel______________________________Email_________________________________________Birthday_______________

                               Dues $15 plus $5 for the Widow's Fund. Make checks payable to FDNY Retired
                         Mail to: Artie Dieck, Financial Secretary, 11721 Spring Tree Lane, Port Richey, Fl. 34668

                                                   OKANE DIVISION ANNUAL DAY AT THE RACES  Feb 19, 2011
                                                               Cut-off date for reservations Feb 12, 2011
NAME(S)____________________________________________________________Phone___________________

Address______________________________________________________________________________________

Number Of Guests (Include Yourself)_______ @ $20 = Total $_________Make Checks Payable to:   FDNY Retired

                    Mail to: Joe Baal - 180 Balsam Drive, Oldsmar, Fl. 34677 Tel: (727) 787-8749

                               28th ANNUAL "JIM CERSOSIMO MEMORIAL SERVICE & BREAKFAST"
       
                         Memorial Ceremony to be held on 3/3/12 at 9:00 AM at Timber Green Country Club. 
                    Breakfast immediately after Ceremony, Cut Off date for reservations : February 29, 2012

  Name(s)_______________________________________________________Phone________________________

   Address____________________________________________________________________________________

   I/we would like to be seated with____________________________________________________________

  Number Of Guests (Include yourself)______@ $10.00 each = Total $          Make checks payable to FDNY Retired. 
            Mail Reservations to: Jim Barry, 8209 Cavalry Drive, Bayonet Point, Fl , Fl 34688 (727) 869-6602

         PLEASE PRINT                                  BOOSTER APPLICATION                                            PLEASE PRINT
Please insert the following booster(s) in the newsletter. Each Booster costs $5 & will run for one year starting with the next issue. Be sure to include your name as the "DONOR". Make checks payable to FDNY Retired, Mail to: FDNY Retired, Box 76, Port Richey, Fl 34673-0076                        
____________________________________________________________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

Donor's  Name_______________________________________________________________________________________
_______________________________________________________________________________________

   PLEASE PRINT                                 REQUEST FOR  "SPRING PICNIC"  TICKETS                              PLEASE PRINT
                                                                      Cut Off Date March  24, 2012
                                       Each person attending must have a ticket. Tickets cost $5 each
 
Please find enclosed my check in the amount of $_______ payable to FDNY RETIRED for #________ tickets. I understand that when each eligible person attends the picnic & turn in his ticket, the money for each attendee will be returned. Make checks payable to FDNY Retired.
 
Mail to: Jim Barry. 8209 Cavalry Drive, Bayonet Point Fl 34667. You must enclose a self addressed, stamped envelope to facilitate mailing your tickets to you. Sorry, requests received after March 24th will be returned.

                                                                               Signed_____________________________________________

                                            
                                         APPLICATION FOR MEMBERSHIP IN THE
                                       GENE OKANE DIVISION OF FDNY RETIRED                                                       
                                         POST OFFICE BOX 76 - PORT RICHEY, FL. 34673-0076

Please print all information


Name___________________________________________________________________________________________

Address_____________________________________________________Date Of Birth________________________

City_____________________________________________________State________________  Zip_______________

Phone__________________________________Email____________________________________________________

Badge #___________Rank_________Pension Number (include all letters & numbers)__________________________

Date Appointed__________________________________To Unit__________________________________________

Date Retired_____________________________________ From Unit_______________________________________

Units Worked In _________________________________________________________________________________

Retired (check one):   For Service   _________    Ordinary Disability_________Line Of duty Disability ____________

Do you pay retirement dues to UFA or UFOA?  Yes_______ No_________

Wife's Name___________________________________Wife's date of birth ________________________________

                                           Email address if any ___________________________________________

                                                      Summer address if applicable & dates you will be there:

Address_________________________________________________________________________________________

City_______________________________________State_______________ Zip______________________________

Phone________________________ _____Email (if different)______________________________________________

Dates you will be there _____________________________________

                                                              MAIL TO: Artie Dieck, Fiancial Secretary
                                                           11721 Spring Tree Lane, Port Richey, Fl. 34668
                                                                                  (727) 819-8824

                                     Please include a check for $20 ($15 for dues, $5 for Widows/Survivors Fund)

                                                                  Make check payable to: FDNY Retired