PPA Application for Membership – Denver Police Protective Association

I, the undersigned, being employed as a Police Officer in and for the City and County of Denver, State of Colorado, and desiring to make application for membership in the Denver Police Protective Association, hereby certify to comply with all laws, rules and regulations now in force or that may be hereafter enacted. I understand I am to be entitled to participate in all the rights and benefits of the Association.

New Membership or Reinstatement?*

New Membership Application
Reinstatement Application

Name*

First Last

Date of Birth*

Address*

Street Address City State ZIP Code

Social Security Number*

Home Phone*

Cell Phone*

Personal Email*

I hereby authorize that the amount of my longevity benefit, in the event of my death upon completion of 25 years, shall be paid to the following beneficiary or beneficiaries:

Beneficiaries

Name	Relationship	Address
			Edit Delete
There are no Beneficiaries.

Permission to Receive Text Blasts*

Yes
No

Permission to Receive Email Communications*

Yes
No

I hereby authorize the City and County of Denver to deduct from my paycheck and to remit to the Denver Police Protective Association initiation fees, dues and general assessments in amounts from time to time certified by the Denver Police Protective Association. This authorization form shall remain in full force and effect until revoked in writing by me. (Use your mouse on the computer or finger on phone/tablet to sign.)

Signature*

Badge or PR #*