Page 66 - TPA Journal May - June 2018
P. 66
Become A Member of TPA!
Application for Active Membership Active Membership
$30.00
TEXAS POLICE ASSOCIATION
Name _______________________________________________________ Date of Birth__________________________________________
Agency ________________________________________________ Title ________________________________________________________
Your Mailing Address ______________________________________________________________
City _______________________________________________________ State _______________ Zip________________________________
Name of Beneficiary _________________________________________________________________________________________________
*Email Address (optional)____________________________________________________________________________________________
Membership dues include a subscription to the Texas Police Journal. ($30.00)
Mail application and dues to:
I certify that the beneficiary named above is correct according to my wishes.
Texas Police Association
P.O. Box 4247
________________________________________________ ______________________________
Signature Date Austin, TX 78765
Affiliate Membership
$30.00
Application for Affiliate Membership
TEXAS POLICE ASSOCIATION
Name ______________________________________________________ Date of Birth____________________________________________
Agency _________________________________________________________________ Title _________________________________
Your Mailing Address _______________________________________________________________________________________________
City __________________________________________________________ State _______________ Zip___________________________
Name of Beneficiary _________________________________________________________________________________________________
*Email Address ____________________________________________________________________________________________
Affiliate Membership Rates are: $30.00 Annually
Membership Dues are a Tax Deductible Donation
Mail application and dues to:
________________________________________________ ______________________________ Texas Police Association
Signature Date
P.O. Box 4247
Austin, TX 78765
62 www.texaspoliceassociation.com • 866-997-8282 Texas Police Journal
