Fraternal Order of Police Pinellas Lodge 43

Serving Pinellas County Law Enforcement Since 1966

Sick or Distressed Member
Notification
The Sick or Distressed Member form should be used to notify the Lodge of a sickness, injury or death involving one of our Brothers or Sisters, or a member of their family.  This information is confidential and will be provided directly to the FOP 43 Chaplain in order to arrange timely assistance as needed. 
Name:
Member Name,if different
Relationship to Member
Address Line 1
Address Line 2
City
State
Zip Code
Contact Person
Contact Number() -
Details of situation
Cont.