Page 11 - November December 2020 TPA Journal
P. 11

REGISTRATION FORM
                                             Police & Fire Civil Service Act
                                         Chapter 143, Local Government Code
                                          Sheraton Austin Georgetown Hotel
                                                     Georgetown, Texas
                                                  January 19 – 21, 2021

                   Name:
                          1.                                         Title:
                                 (Please Print)
                          TCOLE ID#                                  Email:

                          2.                                         Title:

                          TCOLE ID#                                  Email:

                          3.                                         Title:

                          TCOLE ID#                                  Email:

                   Name of Agency/Organization:

                   Address:
                                 Street or Box                       City                  Zip
                   Phone:                              E-Mail

                                 TPA Member Registration …………...................................$295.00
                                 Non-TPA Member Registration …………………………..………..$345.00

                                         Total Amount Enclosed..........................................$

                   Return to:            Texas Police Association     No refunds, replacements welcome.
                                         P. O. Box 4247
                                         Austin, TX  78765-4247      Invoicing is available upon request.
                                         (512) 458-3140
                                         Or Email to:  mona@texaspoliceassociation.com


                             American Express      Discover     MasterCard          Visa

                   Name (on card):

                   Card Number:                                       Exp. Date:           Sec. Code

                   Signature:                                        Today’s Date:

                                          CASH                               CHECK/MONEY ORDER

                                       **Credit Card Fees will be passed along to Registrant.**
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