Houston Police Retired Officers Association

Houston Police Retired Officers Association
Membership Renewal Form

P.O. Box 130787 Houston TX 77219

Phone/Fax (713) 802-2967 or 1-866-856-7252

PLEASE NOTE: THIS IS NOT THE CORRECT FORM FOR ASSOCIATE MEMBERSHIP

Name*:			Employee Number*:
Spouse's Name:
Your Date of Birth*:

Address:			City:
State:			Zip Code:
Home Phone:*:			Work Phone:
Email Address*:

Suggested membership is $100, ($75 yearly dues and a voluntary contribution of $25 or more will be made to the PAC (Political Action Committee fund), 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 to the TMPA Legal Defense Fund for those who want to carry 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 - Suggested Amount)
TMPA Legal Defense Fund		Yes No (If Yes $40 Fee)
Total Amount		$

Please give us your credit card information for payment:

Credit Card Information (all fields required)

Card Type

Cardholder's First Name

Cardholder's Last Name

Credit Card Number

Exp Date
(e.g.: 05/2020)
Security Code

Cardholder's Billing Street Address

Billing City

Billing State
(2-digit state code)
Billing Zip Code

Billing Country
(2-digit country code)

"You will receive an email confirmation within 5 minutes confirming your payment.

If you do not receive an email confirmation, please call our office at 713-802-2967.

Thank you."