Application for Membership

Please fill in the following form, copy the form and email it to

Last Name:
First Name:
Street Address:
Village: (You don't have to live in the Incorperated Village)
Zip Code:
Home Phone Number:
Cell Phone Number:
I am at least 19 years of age:
I have a valid New York State Drivers License:
When is the best time to contact you? Hour(s) & Day(s)
Comments (optional):

Note: You must be a resident of Valley Stream to be considered for membership in the Valley Stream Civilian Patrol. All information must be filled out for your application to be processed. After submitting this form, your application will be reviewed and an interview scheduled. Thank you for your interest in the Valley Stream Civilian Patrol.