Information Verification Form

Verify Membership Info

With the changes being made in the way we keep track of our members, we are taking this opportunity to varify the information we have on file for our members.

Please fill out the form below as compeltely and accurately as you can. We appreciate the time you have taken to help us.

DPSST Number: *

or I don't have a DPSST Number

Agency/Organization:*

Title:*

Name:*

First *

M.I. *

Last *

Suffix

Gender:*

Email*:

Mailing Address:

Street *

City *

State *

Zip *

Phone:

Area*
( )

Number*
-

Status: *

Active

Retired

Subchapter: *

Each OPOA Member can also be a member of one of the three subchapters:

None

Background Investigators Association

Oregon Association of Property & Evidence Officers

Oregon Association of Reserve Peace Officers

Beneficiary:
(for death benefit)

Beneficiary Address:

Street

City

State

Zip

Comments:

Confidentiality Notice: While using this site, you may choose to submit personal information through email or on-line forms. We use this information for the sole purpose of processing requests and to better serve our members. We will never sell, share, or distribute your personal information to third parties.

* Represents Required Fields