WPOA MEMBERSHIP APPLICATION
Please click File, then Print to print this application

Member Information

Last Name ___________________________ First Name _____________________ Middle ______________

Mailing Address ________________________________________________________ Ph (___)___________
(Street/P.O., City, State, & Zip Code)

E-Mail _______________________________________________________________ Birthdate ___________

Job Information:

Agency Name ________________________________________________ Rank/Title ____________________

Agency Address _________________________________________________________ Ph (___)___________
(Street, City, State, & Zip Code)

Payment:

[ ] By credit Card

Credit Card # ______________________________ Expiration (MM/YY)_______ Security Code _______
(make sure that name and address above matches your Credit Card billing statement)

[ ] Check is enclosed (Make check payable to: WPOA)

Member Status:

[ ] Active Member must be a fully-sworn officer listed under 830 P.C. to 830.5 P.C. of 
the California Penal Code.

[ ] Associate member does not meet above qualifications.

Prior Member? Yes [ ] No [ ] Previous Name?? ________________________________________

I understand that the provisions of the By-Laws of this Association, as the same now
exists,  or may hereafter be modified, amended, or enacted, are binding upon me. The
required membership dues or information are included with this application.

Signature ______________________________________ Date __________________

Mail To: Make check payable to: WPOA.
WPOA
P.O. Box 589 
Sacramento, CA 95812
Annual dues are $60.00. Membership begins the calendar month in which your payment is
received. Annual dues paid by city or state agency are $60.00.