Membership Services

First Name		MI			Last
Rank:				Soc. Sec. No.
Assignment (Circle One)	SWAT Patrol CNT TEMS Other (Describe):
Agency Name
Street Address
City						State		Zip
Agency Phone						Agency Fax
Agency Email Address (print clearly)
Mailing Address (if different from above)
City						State		Zip
Home Phone						Home Fax
Home Email Address (print clearly)
Send Membership Mail to:						Home † Agency †
New Member Signature:
MEMBERSHIP WILL NOT BE ACCEPTED WITHOUT $25.00 PAYMENT
Check No			Amount:
VISA/MasterCard/Am Ex Credit Card No.
Name on Card							Expiration Date
Cardholder Signature

Mail or fax completed membership application to:

Pennsylvania Tactical Officers Association

PO Box 86, Jamison, PA 18929

Telephone and Fax 215-887-1457

Employment Verification

Verification of law enforcement employment required. A copy of your agency ID or letter from your supervisor on agency letterhead verifying your employment must accompany your membership application. Applications without this information will be returned.