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

NEW ASSOCIATE MEMBERSHIP FORM

Fields marked with * are required, Complete all applicable fields fully, leave non-applicable fields blank:
 
Name*:     Employer/Retired from*:
Spouse's Name:    Position Held *:  
SS#*:  Last 4 #'s Only      
Date of Birth *:   Date Sworn In:  
Email Address:    Date Left:  
Home Phone:    Work Phone:  
Address, City, State, Zip*  
If former HPD employee select from the drop down menu, I left HPD because   

       Membership is $50 per year. Voluntary PAC contribution asked - suggested $25.00. TMPA Critical Incident insurance $40.00 for
Honorably Retired Texas Law Enforcement Officers. Renewal notices mailed the month prior to annual expiration.
Annual Dues   $50.00
PAC Donation   $ (ex. 25 - Suggested Amount)
TMPA Legal Defense Fund   Yes No (If Yes $40 Fee) 
Total Amount   $

Enter Credit Card Information Below or send payment to the address at top of form 

I certify that I am an Honorably Retired TCOLE Texas Law Enforcement Officer
having retired from:            

Pay by Check*      

Pay by Credit Card*

 



 
Credit Card Type*      Discover

American Express

MasterCard

Visa

 
Name of Person on Card*



 
Credit Card Number*
 

Expiration Date*
  (ex. 10/06)


I understand that current Associate Membership in the Houston Police Retired Officers Association  is a privilege that allows
me the opportunity to attend and participate in all regular meetings and association functions.  I understand that I can not vote or
propose a motion
on any issue that may be brought before the Regular Membership for action.  I understand  that I can not
stand for any election or serve as chairman of any committee, but can serve on a committee if I so desire and I am approved
by the HPROA President.

I certify I have not been arrested, charged, indicted, tried and/or convicted - adjudicated or non-adjudicated
 - for any felony or for any misdemeanor involving moral turpitude. [City/J.P. Court traffic offenses are exempted]
 


 
 

  Associate's Name*: Member's Name*:  


                    Signature_________________                  Signature________________________