Houston Police Retired Officers Association
P.O. Box 130787
Houston, Tx. 77219-2288
Phone/Fax (713) 802-2967 or 1-866-856-7252


 Application for Membership Or  Address/Phone Correction
PLEASE NOTE:  THIS IS NOT THE CORRECT FORM FOR ASSOCIATE MEMBERSHIP
 
Name*: Employee Number*:
Spouse's Name:        Your HPD Class Number*: 
Your Date of Birth*: Your Date of Retirement*:
 
Address*:  City*:
State*:  Zip Code*:
Home Phone*:  Work Phone:
Email Address*:   SS#* (Last 4#s)***-**- 
 
Gender: Male  Female
Referred By: 
Marital Status: Married  Single  Widowed
If you are a widow and have remarried, please give full name of deceased spouse: (deceased officer)
I am presently enrolled in the D.R.O.P. program. Yes  No
 
Suggested membership is $100, ($75 yearly dues and a voluntary contribution of $25 or more will be made to the PAC (PoliticalActionCommitteefund), for a total of $100 or more. Yearly membership will be renewable annually and a reminder will be mailed to you prior to that date each year.
Add $40 to tothe TMPA Legal Defense Fund for those who want to carry TMPAprovided insurance for firearms coverage.

Members are required to be receiving a retirement benefit from the Police Officers Pension System, City of Houston, or presently enrolled in HPD D.R.O.P and hereby apply for membership in the HOUSTON POLICE RETIRED OFFICERS ASSOCIATION (HPROA).
 
Please fill in amounts:
 
Annual Dues $75.00
PAC Donation $ (ex. 25 - SuggestedAmount)
TMPA Legal Defense Fund  Yes No (If Yes $40 Fee,) 
Total Amount $
 

Please give us your credit card information for payment, or print form and send payment to the address shown at top of form

NOTE:  MEMBERSHIP APPLICATIONS ARE SUBMITTED TO THE BOARD OF DIRECTORS ON THE SECOND THURSDAY OF EACH MONTH.
Onceapproved you will recieveyour membership package. Please allow 3-4 Weeks total from date the application was submitted

 
Credit Card Type*      Discover

American Express

MasterCard

Visa

 


Name of Person on Card*

 


Credit Card Number*

 

Expiration Date*
  (ex. 10/06)