BE SURE TO PRINT THIS OUT BEFORE YOU PRESS SUBMIT.  MAIL THIS WITH YOUR MEMBERSHIP DUES.

NAME: RANK:
Date of Birth: (mm/dd/yyyy)      
Agency:      
Agency Address:      
Agency Phone: (555-555-5555) Fax:
Home Address:      
Home Phone: Mobile:
Pager: Email:
Primary Assignment:  (patrol, narcotics, corrections, etc)
Collateral Assignment:  (SWAT, crisis, negotiations, etc)  
Does your agency have a special response team?  (yes/no)  
Number of team Members:      

Enclose check or money order for $20.00 made payable to the LOUISIANA TACTICAL
POLICE OFFICERS ASSOCIATION. Please mail application to P.O. Box 1510,
Alexandria, LA 71309. Completed application must be accompanied by a photocopy of
the applicants commission card or departmental I.D.


Individual membership is allowed 1 (one) vote in LTPOA business.

 ELECTRONIC SIGNATURE:     (initials: ie. PAG)

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