Page 37 - Texas Police Journal November- December 2013
P. 37
Become A Member of TPA!
Application for Active Membership Active Membership
TEXAS POLICE ASSOCIATION $30.00
Name _______________________________________________________ Date of Birth__________________________________________
Agency ________________________________________________ Title ________________________________________________________
Your Mailing Address ______________________________________________________________
City _______________________________________________________ State _______________ Zip________________________________
Name of Beneficiary _________________________________________________________________________________________________
(Active Membership Includes $4,000.00 Accidental Death Benefit)
*Email Address (optional)____________________________________________________________________________________________
Membership dues include a subscription to the Texas Police Journal. ($30.00)
I certify that the beneficiary named above is correct according to my wishes. Mail application and dues to:
Texas Police Association
________________________________________________ ______________________________ P.O. Box 4247
Signature Date
Austin, TX 78765
Active Membership
$30.00
Application for Active Membership
TEXAS POLICE ASSOCIATION
Name ______________________________________________________ Date of Birth____________________________________________
Agency _________________________________________________________________ Title _________________________________
Your Mailing Address _______________________________________________________________________________________________
City __________________________________________________________ State _______________ Zip___________________________
Name of Beneficiary _________________________________________________________________________________________________
(Active Membership Includes $4,000.00 Accidental Death Benefit)
*Email Address (optional)____________________________________________________________________________________________
Membership dues include a subscription to the Texas Police Journal. ($30.00)
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, TX 78765
Nov./Dec. 2013 www.texaspoliceassociation.com • 866-997-8282.texaspoliceassociation.com • 866-997-8282 35
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