HOUSTON POLICE RETIRED OFFICERS ASSOCIATION
APPLICATION FOR NEW MEMBER

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.

First Name: (in full) *

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:


Membership Dues:

$75.00 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) *
Yes ($40.00) 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.

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)
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)

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