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Christmas Party                                Reservation Form                                     Christmas Party 


Please make my reservation (s) for the Okane Fall Christmas Party to be held on Tuesday, December 21, 2021 at the American Legion Hall. 


Please find enclosed my check ($5 per person) in the amount of $_______ payable to FDNY Retired. 


Please mail to FDNY Retired, P.O. Box 76, Port Richey, Fl 34673-0076 before the cut off date of December 14th, 2021 



2021 CLUB DUES - NOTIFICATION 


Your 2022 dues will be due Jan 31, 2022 . The club dues is 20 + $5 for the Widows/Survivors Fund. Avoid the rush & be the first to pay your 2020 dues. Simply fill out this coupon & mail in with your check payable to FDNY Retired . Most important, please legibly print your current email address. This will enable us to keep the club's email list current & enable you to continue to receive club info via the internet. 


Member’s Name_(print)_________________________________________________________________________________________________


Spouse’s Name____________________________________     Pension # (Include all letters & numbers)_____________________________ 


Address_______________________________________________________________________________________________________________


Tel_____________________________________Email____________________________________________________Birthday______________


Dues $20 plus $5 for the Survivors Fund. Make checks payable to FDNY Retired 

Mail to: Mike Doyle, Financial Secretary, 7637 Deedra Circle, Port Richey, Fl 34668   ​


APPLICATION FOR BOOSTER 

 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_______________________________________________________________________________________ 



APPLICATION FOR MEMBERSHIP IN THE GENE OKANE DIVISION OF FDNY RETIRED 


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 ______________ 


Mike Doyle , Financial Secretary 

7102 Grand Blvd., New Port Richey Fl, 34652 

(727) 819-8824 

Please include a check for $25 ($20 for dues, $5 for Widows/Survivors Fund) 

Make check payable to: FDNY Retired