Bergen County Police Chiefs Association     
Incorporated 1930
Chief Michael Saudino, Emerson Police Department
President

Roster Book Update Form 

Active, Provisional and Retired Chiefs

Please provide as much information as possible in the form below. We are asking that email addresses be provided in
order to be able to communicate with our members in a more timely manner.

Use the "Tab" key to move between fields.

Required Information ( * - Required )
Member Type: *  

*

 
Middle Initial  
Last Name *  
 
Email Address *  
 
Police Department Information ** Active and Provisional Members Only **
 
City  
State  
Zip  
 

Telephone #'s:

   
Main Department #  
Department Fax #  
 
Cell #  
Office Fax #  
 
 

Date Retired (If Applicable)

 
 
Personal Information
 
City  
State  
Zip  
 
Spouse's Name  
Additional Information: