Page 26 - TPA Journal May June 2024
P. 26

GIFT Application for Membership
                                     Texas Police Association


             Active (Law Enforcement) - $30.00               Agency Affiliate - $25.00 Per Officer


                 Name                                                Date of Birth

                 Agency/Company                                      Title

                 Mailing  Address

                 City                            State               Zip

                 Contact  Phone Number

                 E-mail  Address

                 Name  of  Beneficiary
                              (Active Membership Includes $7,500.00 IN THE LINE OF DUTY & Accidental Death Benefit)
                 I certify that the beneficiary named above is correct according to my wishes.


                 Signature                                           Date

                 Mail Application and Dues to:   Texas Police Association, P. O. Box 4247, Austin, Texas 78765-4247

                       Special Gift  from:
                                           Name                            Email  Address



                                          GIFT Application for Membership
                                     Texas Police Association

          Student - $10.00          Citizen - $150.00         Business - $500.00          Donation - $

                 Name

                 Agency/Company                                      Title

                 Mailing  Address

                 City                            State               Zip

                 E-mail  Address

                 Contact  Phone Number



                 Signature                                           Date

                 Mail Application and Dues to:   Texas Police Association, P. O. Box 4247, Austin, Texas 78765-4247

                       Special Gift  from:
                                           Name                            Email  Address


        22                 www.texaspoliceassociation.com • (512) 458-3140             Texas Police Journal
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