Membership Request

Membership Form

Thank you for your interest in joining the Black Police Association of Greater Dallas. Please complete the form below. Your application will be reviewed by one of our administrators and once approved, you will be notified to then set up dues payment.

Individuals who are non-City of Dallas or Dallas ISD employees, employed with another law enforcement agency must contact the BPA office for membership eligibility and application information.

First Name(*)

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Last Name(*)

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Middle Initial

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Cell (123) 222-2222(*)

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Home Phone (123) 222-2222

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Personal Email (no work email addresses accepted)(*)

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Re-type Email(*)

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Street Address(*)

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Apt/Suite

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City(*)

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State(*)

Please select state

Zip(*)

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DOB(*)

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Work Details -

Badge #(*)

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Employee #(*)

Please provide employee #

Rank(*)

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Police Department/Agency [i.e. Dallas Police, Dallas ISD, Dallas City Marshal Offc.](*)

Please list your department

Division(*)

Please Division

Street Address(*)

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Apt/Suite

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City(*)

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State(*)

Please select state

Zip(*)

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Please read and check (1) the "verification of accuracy" box, (2) the appropriate "Place of Employment" box, (3) check the Payment Authorization box to authorize deduction, (4) type your name in the digital signature field to complete your application.

Verification of accuracy (*)

I hereby acknowledge the above information is accurate to the best of my knowledge and that to supply information that is knowing false or inaccurate is a violation.

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Place of Employment (*)

Dallas Police or City Marshal
Dallas ISD
Outside Agencies

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Dallas Police or City Marshal

Payment Authorization(*)

Once my application has been APPROVED (submission of from initiates review process only), I hereby authorize the City of Dallas, City Manager and the city Auditor to deduct and pay to the organization named $35.00 monthly from salary or wages for the membership dues in the Black Police Association of Greater Dallas. I understand these dues may be raised or lowered by the organization in accordance with the organizations bylaws, policies and procedures. As provided by resolution of the City Council of the City of Dallas, April 10, 1972. Such deductions shall be in accordance with the policies covering payroll deductions, including policies to allocate such deductions to semi-monthly, bi-weekly, or weekly deduction schedules. The authorization is effective the first deduction period after submitted and shall continue until cancelled by the applicant or organization.

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Dallas ISD

Payment Authorization(*)

Once my application has been APPROVED (submission of from initiates review process only), I hereby authorize Dallas ISD Payroll Department to deduct and pay to the organization named $35.00 monthly from salary or wages for the membership dues in the Black Police Association of Greater Dallas. I understand these dues may be raised or lowered by the organization in accordance with the organizations bylaws, policies and procedures. Such deductions shall be in accordance with the policies covering payroll deductions, including policies to allocate such deductions to semi-monthly, bi-weekly, or weekly deduction schedules. The authorization is effective the first deduction period after submitted and shall continue until cancelled by the applicant or organization.

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I confirm(*)

YES - I confirm I have read and approve the above disclaimers

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Digital Signature - Type name here (*)

Please confirm you have read and approve the above disclaimers by typing your name here.

New Membership Form

Work Details -

Please read and check (1) the "verification of accuracy" box, (2) the appropriate "Place of Employment" box, (3) check the Payment Authorization box to authorize deduction, (4) type your name in the digital signature field to complete your application.

Dallas Police or City Marshal

Dallas ISD

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