TCSOA Membership Application

Travis County Sheriff’s Officers Association
3800 North Lamar Blvd., Suite 200, Austin, Texas 78756
512 289-5916

DATE:

LAST NAME: FIRST NAME SSN: xxx-xx- (last 4) DOB:

Home Address: City: Zip:

Home Phone: Work Ext:

Personal Email Address:

License Held: Date of Hire: Current Bldg: Team:

Type of Membership: (Check one – below check the desired deductions) Regular (Sworn and Non-Sworn Staffers)

Dues to be Deducted:
ASSOCIATION FEE CLEAT PAC (Optional) AFLAC OTHER TOTAL

Referred by:

Signature:

Use your mouse, finger, or touch device to write your signature.

Enter the text shown in the image above.