Associate Renewal (Non-HPD Officers)

HOUSTON POLICE RETIRED OFFICERS ASSOCIATION
ASSOCIATE MEMBER RENEWAL FORM

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.
Please do not leave any of the below fields blank. Enter NA if not applicable.

First Name: (in full) *

Last Name: *

Cell Phone: *

Home Phone:

Email Address: *

Home Street Address: *

City: *

State: *

Zip Code: *

Associate Membership Renewal 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 $40 Fee) * This coverage is only available for Texas Honorably Retired TCOLE Law Enforcement Officers from agencies other than HPD.

Yes ($40.00) No ($0.00)

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

Total Amount Due:
$

YOU WILL BE PROMPTED TO PRINT THIS FORM AFTER CLICKING "SUBMIT APPLICATION.
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, MAIL PAYMENT AND SIGNED APPLICATION 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)

Card Type

Cardholder's First Name

Cardholder's Last Name

Credit Card Number

Exp Date
(e.g.: 05/2022)
Security Code

Cardholder's Billing Street Address

Billing City

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

Billing Country
(2-digit country 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]