Washington Staff Assault Task Force

P.O. Box 363, Olympia, WA 98504 (509) 301-8874

As a member of WSATF, I receive a Benefit in an insurance of a $10,000 Life Insurance Policy. I hereby make this application for membership in Washington Staff Assault Task Force (WSATF). I hereby authorize WSATF to make a monthly $12.00 recurring charge to my bank account for membership with WSATF. This authority will remain in effect until WSATF is notified by me in writing to cancel membership in such time to allow WSATF and Bank Institution a reasonable opportunity to act on it. Upon my retirement, I agree to become a $5.00 a month WSATF Associate Member.

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First Name: required
Last Name: required
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Member nine-digit SSN:required
Institution Main:required
Bank Name:required
Routing Number:required
Account Number:required
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Name on the Account:required
Beneficiary Name:required
Beneficiary Birth Date:required
Beneficiary Address:required
Beneficiary Gender:required
Beneficiary Relationship:required
Please Enter Your Name as Electronic Verification of Your Application:required

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