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(*)

Invalid Input

Last Name(*)

Invalid Input

Middle Initial

Invalid Input

Cell (123) 222-2222(*)

Invalid Input

Home Phone (123) 222-2222

Invalid Input

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

Invalid Input

Re-type Email(*)

Invalid Input

Street Address(*)

Invalid Input

Apt/Suite

Invalid Input

City(*)

Invalid Input

State(*)

Please select state

Zip(*)

Invalid Input

DOB(*)

Invalid Input

Work Details -

Badge #(*)

Invalid Input

Employee #(*)

Please provide employee #

Rank(*)

Invalid Input

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

Please list your department

Division(*)

Please Division

Unit/Team/Area

Please provide your Unit/Team/Area

Street Address(*)

Invalid Input

Apt/Suite

Invalid Input

City(*)

Invalid Input

State(*)

Please select state

Zip(*)

Invalid Input

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.

Invalid Input

Place of Employment (*)

Dallas Police or City Marshal

Dallas ISD

Invalid Input

(used for payment authorization deduction)

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.

Invalid Input

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.

Invalid Input

I confirm(*)

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

Invalid Input

Digital Signature - Type name here (*)

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

Completing this field serves as my digital signature for accuracy on the BPA of Greater Dallas Membership form and membership dues payroll deduction authorization.

reCaptcha(*)

Invalid Input

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