Travis County Sheriff’s Officers Association
408 W. 14th St., Austin, TX 78701
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   Associate 

Dues to be Deducted: $7.50 ASSOCIATION  $18.00 CLEAT   PAC  (Optional) AFLAC  OTHER   TOTAL 

Referred by: 

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