YORK REGIONAL POLICE RETIREES ASSOCIATION

600 Stonehaven Avenue, Newmarket, Ontario, L3X 2M4

Membership Application

Active _____ ($50.00) Associate _____ ($45.00) Spouse ____ ($25.00)

Surname: ______________ First Name: _____________Initial: ______
Street: ____________________________________ Apt: _________
Town: ______________ Province: ______ Postal Code: ___________
D.O.B: ________________Telephone: _________________________
E Mail: ___________________________ Cell: ___________________
Employee/Badge # ____________ Years of Service: ______________
Date Joined YRP:___________________
Retirement Date (for Active membership):_______________________
Resignation Date (for Associate membership): ___________________
Rank/Position on Retirement/Resignation:_______________________

Next of Kin:
Name: _____________________ Relationship: __________________
Street: ________________________ Town: __________________
Province: ___________________ Postal Code: __________________
Telephone: ____________________ E Mail: __________________

Definitions: ACTIVE MEMBER: All persons who retire from the York Regional Police or the York Regional Police
Association and who are receiving a pension from OMERS are eligible for Membership in the Association as an Active
Member.
ASSOCIATE MEMBER: An Associate Member shall be a person who had previously served a minimum of ten years with
York Regional Police or the area forces which amalgamated to form such Force on January 1, 1971 and was
honourably separated there from and since separation, his character has been exemplary.

YRPRA Privacy Policy: Use and Distribution of Personal Information

Please read, Sign and Date
a) My personal information shall not be released by any member to anyone outside the York Regional Police
Retirees Association and/or Police Pensioners Association of Ontario (PPAO), unless the York Regional Police
Retirees Association, Board of Directors deems it necessary to provide important information or services to me.
b) Release of my personal information will always be subject to the provisions of the York Regional Police Retirees
Privacy Policy and the PPAO Privacy Code.
I will comply with the York Regional Police Retirees Privacy Policy and will not release any other York Regional
Police Retirees member’s personal information
c) I will comply with the York Regional Police Retirees Privacy Policy and will not release any other York Regional
Police Retirees member’s personal information

SIGNATURE: _______________________ DATE: _______________

********************************** Office ************************************

Approval Date: ___________________ Dues Received: _________________

Mail List: ___________________ E Mail List: __________________________

Please Mail to:

Cheque Payable to: YRP Retirees Association, 600 Stonehaven Avenue, Newmarket,
Ontario, L3X 2M4
Revised: August 23, 2017.