Links to Georgia Law Enforcement Sites

Death Benefit For Active Members Only:
	STEP 3 of 3	Step 1 Pay Dues (click here) Step 2 Complete Member Form (click here) Step 3 Complete Beneficiary Form
Active Members complete and submit form online after completing dues payment. $1000 Regular Benefit, $3000 Line-of-Duty Benefit.

1st Recipient Name:
Relationship:
Street:
City:
State:		Zip Code:
Date of Birth:
If, upon my death, I am entitled to any death benefits, I hereby designate the recipient listed above.
Members Name
Email Address: