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

 
Agency:      
Agency Address:      
Agency Phone: (555-555-5555) Fax:
Commanding Officer:  
Commanding Officer Signature:  (This must be filled out and mailed/faxed to us.)  
Agency Heads Name:          
Full Time or Part Time: Team Number:  

Enclose check or money order for $50.00 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 commanders commission card or departmental I.D.
Team Membership is allowed only 1 (one) vote in LTPOA business.

 ELECTRONIC SIGNATURE:     (initials: ie. PAG)

PRINT THIS PAGE