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Membership Forms | Fairfax 5000

Membership Forms

Thank you for your interest in investing with the Fairfax Coalition of Police.  Please see below for membership forms.


  1. Be sure to fill out both forms.  One is the enrollment form that will be sent to payroll.  The other form is the Life Insurance beneficiary form that we keep on file.
  2. You can email or mail the forms to Mario Colorado at Mason Station, or any Coalition Board Member.  He can also be reached at through county email.  For further questions or assistance you can also call 703-209-8101.
  3. You are covered the minute your forms are in our hands, so don't wait!

Membership Enrollment Form

Life Insurance Enrollment and Beneficiary Change Form