DPSOA CONFERENCE
2004 ~ SOUTH PADRE ISLAND, TX ASSOCIATE
MEMBERSHIP APPLICATION
"Support Your DPSOA Family"
Since the Texas
Department of Public Safety was established, 76 DPS Officers have
been lost in the line of duty. 2004 marks 30 years that the Texas
Department of Public Safety Officers Association, a non-profit
organization, has been dedicated to the aiding of families of DPS
Officers who have been killed in the line of duty. The Death
Benefit Fund, a special fund established by DPSOA, lends financial
support to the family left behind when tragedy strikes. In the
years since it was founded, the benefit has lent vital support in
times of need. The DPSOA invites you to join our cause. Support
the Death Benefit Fund by taking advantage of a unique opportunity
to become a DPSOA Associate Member. Here's the opportunity to join
the ranks of an Association that proudly claims amongst its members
State Troopers, Criminal Law Enforcement Officers, Narcotics
Officers, Texas Rangers, Communications Personnel and other branches
of the state's top law enforcement.
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NAME: |
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COMPANY NAME |
____________________________________________________________ |
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ADDRESS |
STREET (NO P.O.
BOXES)______________________________________
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CITY_______________________________ STATE _____ ZIP_________ |
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HOME PH |
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BUSINESS PH. |
____________________________________________________________ |
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Associate
Membership Desired (Please check one) |
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CORPORATE
PERPETUAL |
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$
1,000 |
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CORPORATE 10 YEARS |
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$
700 |
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INDIVIDUAL LIFETIME |
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$
500 |
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INDIVIDUAL 5 YEAR |
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$
200 |
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ANNUAL |
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$
100 |
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Corporate or Individual Lifetime Individual 5 Years or Annual
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Bumper Sticker
Bumper Sticker
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Windshield Decal
Windshield Decal
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DPSOA Lapel Pin
DPSOA Lapel Pin
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Membership Card
Membership Card
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Bronze Belt Buckle
Bronze Belt Buckle
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Magazine
Magazine
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Wall
Plaque
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Signature of
Applicant:_________________________________________________________
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Date:
______________ Sold By: ________________________________________________
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Amount:
___________________ Check #
________________________________________
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***PLEASE NOTE THAT THE "BOOSTER MEMBERSHIP" HAS BEEN ELIMINATED.
MAIL TO: 2004 DPSOA CONFERENCE
MIKE WIGGINS
P.O. BOX 658
SEGUIN, TX 78156 |
