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Houston Police Retired Officers Association
HOUSTON POLICE RETIRED OFFICERS ASSOCIATION
APPLICATION FOR NEW ASSOCIATE MEMBER

This form is not for Houston Police Department retirees, or those currently in the DROP program; those applicants should complete a regular New Member Application.  All Associate Members must be sponsored by a current HPROA member.  IMPORTANT: Review HPROA Associate Member Guidelines and Benefits before applying.
Note: Applications can take up to 2 months for board approval and processing per HPROA's by-laws.

First Name: (in full) *

Last Name: *

Cell Phone: *

Home Phone:

Email Address: * 

Date of Birth: *


   Home Street Address: *

City: *

State: *

Zip Code: *


All Associate members Must have a HPROA Sponsor; My Sponsor Is: *

Retired Law Enforcement Officers Only

If you are an active or retired police officer (other than HPD), or prior officer, you must complete the following info: 
Employer / Retired From:

Position Held:

   Date Sworn In:

If former HPD, I left because:

Associate Membership Dues:

$50.00 Annual Dues

Optional One-Time Annual PAC Donation: 
A voluntary PAC contribution of $25.00 or more is suggested.  For those contributing with corporate funds, the donation will instead go to the Family Assistance Committee (FAC), rather than the PAC
$

Is the PAC Donation being made from a Corporate Account? *
Yes (Will go to FAC)  No  Not Applicable 

PAC Donation Requirement per Texas Ethics Commission: *
Current Employer & Position, or if Retired, Last Position Held:

Optional TMPA Legal Defense:  (If Yes $60 Fee) *
Yes ($60.00) No ($0.00) 
TMPA Requirements:
 - Texas Honorably Retired TCOLE Law Enforcement Officer from agency other than HPD and
 - Texas resident (coverage applies to out-of-state travel)

Required for TMPA Legal Defense: *
I certify that I am an Honorably Retired TCOLE Texas Law Enforcement Officer having retired from:


Total Amount Due:
$

IF YOU ARE PAYING VIA CREDIT CARD - YOU DO NOT NEED TO PRINT/MAIL IN THE FORM.

You should receive an email confirmation within a few minutes. If not, please call the below phone number for assistance.

If paying by check, click the submit button below and an email will be sent to you with the above application attached.  All you need do is print it out, sign it, and mail it with your payment to:

HOUSTON POLICE RETIRED OFFICERS ASSOCIATION
P.O. BOX 130787, HOUSTON, TX  77219

Call (713) 802-2967 or 1-866-856-7252 with any questions

Please sign below if you are submitting this form by mail.



Signature:



Method of Payment:
 Pay By Check - Print Application and Mail    Credit / Debit Card

Credit / Debit Card Information(all fields required)
Cardholder's First Name *

Cardholder's Last Name *

Cardholder's Billing Street Address *

Billing City *

Billing State *
(2-character state code)
Billing Zip Code *

Billing Country *
(2-character country code)
Card Type *

Credit Card Number *

Exp Date *
(e.g.: 05/2024)
Security Code *

CHECK TO AGREE: 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]

 (Please click only once to avoid double-charging!)