Member-New Application

HOUSTON POLICE RETIRED OFFICERS ASSOCIATION
APPLICATION FOR NEW MEMBER
(Existing or expired members should go HERE to renew their membership)

This form is only for Houston Police Department retirees, active HPD officers who are currently in the DROP program or the surviving spouses of one of these.

Please do not use this form to renew existing or expired memberships.
Existing or expired members should go HERE to renew their membership -or-
Contact our office at (713) 802-2967 or (866) 856-7252 if you are having trouble renewing online.

First Name: (in full) *

Middle Initial:

Last Name: *

Cell Phone: *

Home Phone:

Email Address: *

HPD Employee #: *

Date of Birth: *

Home Street Address: *

City: *

State: *

Zip Code: *

Spouses Full Name:

Date Retired or Date Entered into DROP:

Academy Class Number:

Annual Membership Dues:

Membership: $95.00

PAC Donation: (Optional)
$
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:

TMPA Legal Defense: (Optional)
Yes ($60.00) No ($0.00)
TMPA Requirements:
- Must be an Honorably Retired HPD Officer and
- TEXAS RESIDENT (covers out-of-state travel).

Total Amount Due:
$

If you are paying via credit card - you DO NOT need to print/mail in the form.

If paying by check, select the "Pay By Check" option below, then click the submit button 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

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

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 *

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