Austin Fraternal Order of Police > Membership Application Form

Fraternal Order of Police Austin Lodge 49 Membership Application

Thank you for your interest in becoming a member of the Austin FOP. Please complete the form below.

Membership will not be granted until the Austin Lodge has received your membership dues. Please contact the Lodge with any questions regarding membership dues.

Membership Level* A value is required
Payment* A value is required
Name* A value is required	DOB* A value is required
SSN* A value is required	Email* A value is required
Home
Address* A value is required
Home Phone	Cell Phone* A value is required
Pager
Work
Agency Name* A value is required
Work Address* A value is required
Work Phone* A value is required	Position/Rank* A value is required
TCLEOSE Certification Level* A value is required	Instructor Certification?
Are you willing to instruct?* A value is required
Participation in the Legal Defense Plan *I DO / DO NOT (choose one below) wish to participate in the Texas Labor Council Legal Defense Plan.* I understand my monthly dues would be increased by $15.00, which is the current cost of the program. I further understand the legal defense plan will not go in effect until the first day of the next month after my application is accepted. If I choose not to participate in the legal/labor plan, I understand the lodge, its members or its executive officers are not responsible for any legal fees stemming from any actions connected with my employment. Any actions taken on my part will be at my own expense. I understand that I am responsible for prompt payment of all dues and if I do not keep my dues current I will be dropped without further notice and lose all rights and benefits of the plan into which I enrolled.
A value is required
STATE/LOCAL LODGE INSURANCE BENEFIT ASSIGNMENT In the event of an untimely death, either natural or line of duty, I designate the following beneficiary(s) to receive any and all funds entitled to me as a member of the Fraternal Order of Police, if any, and of which my state or local lodge may have paid a life insurance premium.
Beneficiary 1
Name	Relationship
DOB	SS#
Address
Phone
Beneficiary 2
Name	Relationship
DOB	SS#
Address
Phone
Beneficiary 3
Name	Relationship
DOB	SS#
Address
Phone
OBLIGATION AFFIRMATION* I, [TYPE YOUR NAME HERE],in the presence of the Creator of the universe and the members of the Fraternal Order of Police here assembled, do most solemnly and sincerely promise and swear that I will, to the best of my ability, comply with all laws and rules of this Order; that I will recognize the authority of my legally elected officers and obey all orders therefrom not in conflict with my religious or political views, or my rights as an American Citizen; that I will not cheat, wrong or defraud this Order, or any member thereof, or permit the same to be done if in my power to prevent it; that I will at all times aid and assist a worthy brother or sister in sickness or distress so far as it lies in my power to do so; and that I will not divulge any secrets of this Order to anyone not entitled to receive them. To all of which I most solemnly and sincerely promise and swear. Should I violate this, my solemn oath or obligation, I hereby consent to be expelled from the Order. A value is required
Please type your digital signature.* A value is required	Date* A value is required

Submit
* Required

Fraternal Order of Police

Austin Lodge 49 12407 N. Mopac Ste. 250 Box 386 Austin TX 78758

Home

Work

Beneficiary 1

Beneficiary 2

Beneficiary 3

Austin Lodge 49

12407 N. Mopac

Ste. 250 Box 386

Austin TX 78758