Full Name *

Name

Address *

Please include Apt # and or Building #

City *

State *

Postal code *

Personal Email *

Work Email *

Personal Cell Phone *

Business Phone *

Law Enforcement Agency *

Ak-Chin Police Department
Apache Junction Department of Public Safety
Arizona Attorney General's Office
Arizona Criminal Investigations Division
Arizona Department of Corrections
Arizona Department of Game and Fish
Arizona Department of Juvenile Corrections
Arizona Department of Public Safety
Arizona Department of Transportation (ADOT)
Arizona Highway Patrol
Arizona State Capitol Police
Arizona Office of Inspector General
Arizona State University Police Department
Avondale Police Department
Arizona Department of Liquor Licenses and Control
Buckeye Police Department
Bullhead City Police Department
Casa Grande Police Department
Cochise County Sheriff's Office
Central Arizona College Police Department
Chandler Police Department
Chino Valley Police Department
City of Maricopa Police Department
Clarkdale Police Department
Clifton Police Department
Colorado River Indian Tribes Police Department
Cottonwood Police Department
Coolidge Police Department
El Mirage Police Department
Eloy Police Department
Gila County Sheriff's Office
Fountain Hills Town Marshal
Gila River Tribal Police Department
Gilbert Police Department
Glendale Police Department
Goodyear Police Department
Graham County Sheriffs Office
Grand Canyon University Public Safety Department
Huachuca City Police Department
Hualapai Tribal Police Department
Jerome Police Department
Kingman Police Department
Marana Police Department
Maricopa Colleges Police Department
Maricopa County Sheriffs Office
Maricopa County Corrections Deputies
Mesa Police Department
Mohave County Park Police
Mohave County Sheriff Office
Mohave County Probation
Navajo Tribal Police Department
Northern Arizona University Police Department
Oro Valley Police Department
Page Police Department
Paradise Valley Police Department
Payson Police Department
Peoria Police Department
Phoenix Police Department
Pima County Community College Department of Public Safety
Pima County Sheriffs Department
Pima Police Department
Pinal County Sheriff's Office
Pinetop-Lakeside Police Department
Pima County Animal Control Association
Prescott Police Department
Prescott Valley Police Department
Queen Creek Police Department
Round Valley Police Department
San Carlos Apache Police Department
San Luis Police Department
Santa Cruz County Sheriff's Office
Scottsdale Community College Security Department
Scottsdale Police Department
Show Low Police Department
Sierra Vista Police Department
Snowflake-Taylor Police Department
South Tucson Police Department
Springerville Police Department
Superior Police Department
Surprise Police Department
San Luis Police Department
Safford Police Department
Tempe Police Department
Thatcher Police Department
Tohono O’odham Police Department
Tonto Apache Police Department
Tucson Airport Authority Police Department
Tucson Police Department
Tombstone City Marshal's Office
University of Arizona Police Department
Wickenburg Police Department
Williams Police Department
Willcox Department of Public Safety
Yavapai County Probation Department
Yavapai County Sheriffs Office
Yuma County Sheriffs Office
Yavapai County Court Security Officers
Yuma Police Department
Other (Enter Agency)
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Agency (other)

Job Title - Officer, Sergeant, Dispatcher, etc. *

Association

CCLEA - Cochise County Law Enforcement Association

ACDA - Apache County Deputies
ADCJP - Pima Juvenile Correction
ADISA - AZ Department of Insurance Special Agent
ADJCA – Arizona Department of Juvenile Corrections Association
AZTA - AZ Dept of Transportation
AGSAA - Atty General Special Agents
AJPOA - Apache Junction Police Officers Association
APDU – Avondale Police Department United
ASUPOA - AZ State University
AZCP - Arizona Corrections Professionals
AZGFD - AZ Game & Fish Department
AZLC - AZ Liquor Control
AZPRS - AZ Parks & Recs
AZ Rangers
AZLC - Arizona Department of Liquor Licenses and Controlype an Option
AZSPOA - AZ State Police
AZOIG - Arizona Office of Inspector General
BHC - Bullhead City Police
BNPOA - Benson Police
BPOA - Bisbee Police
BUPOA - Buckeye Police Officer's Association
CACPOA - Central AZ College Police
CCLEA - Cochise County Law Enforcement
CCPA - Cochise County Probation
CDPOA - Clarkdale Police
CGPOA - Casa Grande Police
CGPSA - Casa Grande Police Supervisors
CLASA - Chandler Lieutenants & Sergeants
CLFTPOA - Clifton Police
COCOP - Cocopah Tribal Police Officers
COCPROB - Coconino County Probation
COCSA - Coconino Sheriffs
CCPOA - Coolidge Police Officers Association
CPSA - Cottonwood Public Safety
CUPDA - Chandler Unified Police Department
CVPOA - Chino Valley Police
CPVSA - Camp Verde Public Safety
CRITPOA - Colorado River Indian Tribes Police Officer Association
DPOA - Douglas Police
EPOA - Eloy Police
FCSO - Federal Court Security Officers
FMTP - Fort Mohave Tribal Police
FPOA - Florence Police Officers
GCLEA - Greenlee County Law Enforce
GCDSA - Gila County Deputy Sheriffs
GCPA - Gila County Probation Officers
GCUPOA - Grand Canyon University Police Officer's Association
GDPOA – Goodyear Police Officer Association
GLBPOA - Globe Police Officers
GPLA - Gilbert Police Leadership Association
GPLAM - Gilbert Police Leadership Association Medics
GPLAR - Gilbert Police Leadership Association Retired
GRAHDSA - Graham County Deputies
GRPOA - Gila River Police
HAYPOA - Hayden Police Officers
HCPOA - Huachuca City Police
HOLPOA - Holbrook Police Officers
HUALAPAI POA - Hualapai Police Officers
CCLEA - Cochise County Law Enforcement Association
JPOA - Jerome Police Officers
KPOA - Kingman Police Officers
KRNYPOA - Kearny Police Officers
LHC - Lake Havasu City
LPCLEA - La Paz County Law Enforcement
MCCDA - Maricopa County Corrections Deputies
MCCPOA - Maricopa Community College Police
MCPP - Mohave County Park Police
MCDA - Maricopa County Deputies
MCDOA - Mohave County Dentention Officers
MCPA - Maricopa County Probation
MCPROB - Mohave County Probation
MCSCA - Maricopa County Sheriff's Civilian Association
ME - Maricopa Employees
MIAPOA - Miami Police Officers Association
MOCDA - Mohave County Deputies
MPCA - Marana Police Commanders
MPOA - Marana Police Officers Assocation
MPPL - Mammoth Police
NAUPOA - Northern AZ University Police
NCDA - Navajo County Deputies
NCPOA - Navajo County Probation
NPOA - Nogales Police
OVLA - Oro Valley Lieutenants
Oro Valley Police Officers Association
PAPA - Payson Arizona Police Association
PAPOA - Parker Police
PASQPOA - Pasqua Yaqui Police
PAYPOA - Payson Police Officers
PCACIA - Pima Cty Attorney Crime Investigators
PCACP - Pima Cty Assoc of Correct Prof
PCAIO - Pinal Cty Attorney Invest Officers
PCCO – Pima County Corrections Officers
PCCPOA - Pima Cty College Police
PCDA - Pinal County Deputies
PCDO - Pima County Deputies
PCPOA - Pima County Probation Officers
PCPROB - Pinal Cty Probation
PCSCA - Pima County Sheriff Commanders Assoc
PDVPOA - Paradise Valley Police
PIMAPOA - City of Pima Police Officers Association
PLPOA - Pinetop Lakeside Police
POSA - Police Officers of Scottsdale Arizona (Includes OFC's, SGT's & LT's)
PPA - Phoenix Police
PPOA - Peoria Police Officers Assoc
PPSLA - Phoenix Police Sgts & Lts
PPSLAA - Phoenix Police Sgts & Lts - Associates
PPSLAR - Phoenix Police Sgts & Lts - Retirees
PVPDCA Prescott Valley Police Commanders
PCACA - Pima County Animal Control Association
PPDA - Prescott Police Department Association
PVPOA - Prescott Valley Police Officers
QCPOA - Queen Creek Police Officer Association
QPOA - Quartzsite Police Officers
RETIRED - Retiree Members
RVPOA - Round Valley Police Department
SAFPOA - Safford Police
SCCA - Santa Cruz Commanders
SCCAG - Santa Cruz County Attorney General
SCDA - Santa Cruz Deputies
SFTPOA - Snowflake-Taylor Police Officers
SHOWPOA - Show Low Police
SLEA - Sedona Law Enforcement
SLPOA - San Luis Police Officer's Association
SOMPOA - Somerton Police Officers
SPOA - Sahuarita Police
SRPOA - Salt River Police
SUPPOA - Superior Police Officer's Association
STPOA - South Tucson Police Officers
SVPOA - Sierra Vista Police
SLPOA - San Luis Police Officer's Association
TAPOA - Tucson Airport Police Officers
TCMO - Tombstone City Marshal's Office
TLEA - Thatcher Law Enforcement Association
TONAPAPOA - Tonto Apache Police
TOPD - Tohono O'odham Police
TPCA - Tucson Police Commanders
TPPL - Tucson Police Protective League
TUSDOA - Tucson Unified School District Officers
UAPOA - University Police Officers
UPOP – United Police Officers of Page, Arizona
USBPA - US Border Patrol
USCBP - US Customs & Border Protection
USPOA - US Probation Officers
WELLPOA - Welton Police
WMAPOA - White Mountain Apache Police
WPDA - Williams Police Department
WPOA - Winslow Police
YAVPROB - Yavapai County Probation
YCLA - Yavapai County Lieutenants
YCPA - Yavapai College Police
YCDA - Yuma County Deputies Association
YCPROB - Yuma County Probation Officer
YPGPA - Yuma Proving Ground Police
YPOA - Yuma Police Officers
YPSA - Yavapai County Deputies
YPTPOA - Yavapai Prescott Tribal Police Off Assoc
YCCSO - Yavapai County Court Security Officers
YSCSA - Yavapai Superior Court Security
Other (Enter Association)
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Association (other)

Bank Name *

Account Number *

Routing Number *

Bank Account Type *

Checking
Savings
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**Your account information is kept secure. Dues will be withdrawn from your bank account on or near the 20th of every month. If the 20th falls on a weekend or holiday, it will be withdrawn the next business day.

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