OPOA Mail-In Membership Application

 Print and mail completed application to OPOA with your check or credit card information

Circle one  - Active Member  /  Associate Member  /  Lifetime Member

Name & Title: _____________________________________________________________________________________

Organization/Agency: _______________________________________________________________________________

Address: _________________________________________________________________________________________

City, State & Zip Code: _____________________________________________________________________________

Phone Number: ________________________    Email: ________________________________

Beneficiary & Address ( for Death Benefit): ____________________________________________________________

_________________________________________________________________________________________________

Amount Submitted: _________________  (New Member: $25.00; Renewing Member: $15.00;  Life Member: $250.00)

Credit Card Type: ________________________

Credit Card Number: _____________________________________ Expiration: ____________Security Code:________

Signature:_________________________________________________________________________________________

Special Chapter:  Circle one or more (dues include one subchapter membership, each additional subchapter is $2.50)

  1) Robbery- Homicide                2) Child Abuse-Sex Crimes          

  3) Background Investigators      4) Reserve Peace Officers

  5) Property and Evidence Officers

Mail application to OPOA, PO Box 9211 Brooks, OR 97305