Page 13 - November December 2019 TPA Journal

Registration Fee: $845.00- Member
$895.00- Non-member
Or https://www.eventbrite.com/e/
2020a-law-enforcement-lead-
Click Here to Register On-Line: Register Here
ership-conference-tickets-

80583939733

Complete the form below and return it with payment

Texas Police Association Return This Form To: Texas Police Association
Registration Form P. O. Box 4247, Austin, TX 78765
Law Enforcement Leadership Conference Fax (512) 458-1799: (512) 458-3140

TCOLE ID# Last Name (Include Sr., Jr., Etc.) First Name Middle Initial

Date of Birth (mo-day-yr) 5HJLVWUDQW¶V 5DQN RU 7LWOH Classification: [ ] Peace Officer [ ] Corrections
[ ] Reserve Officer [ ] Elected Official
[ ] Other

Name of Law Enforcement Agency Address City Zip

Agency Telephone Number E-mail address

Return Confirmation & Receipt to:

TPA Use Only:
Date Confirmation Mailed/Faxed/E-Mailed:

Paid: $ [ ] City/County/State Check [ ] Personal Check #

Am Express Discover MasterCard ___ Visa

Name

Card Number Expiration Date

Security Code Signature

Feel free to duplicate this form as may be needed.

Nov./Dec. 2019 www.texaspoliceassociation.com • 866-997-8282 9