Membership Application

Any item marked with an * is a required field if it applies to you.

I would like to be an ACTIVE/REGULAR MEMBER of HISLEA (Sworn Law Enforcement Only).   Annual Membership Dues are $25.00.

I would like to be an ASSOCIATE MEMBER of HISLEA (Civilian Member Only)Annual Membership Dues are $25.00.

I would like to be an HONORARY MEMBER of HISLEA (Retired Sworn Law Enforcement Only).  Annual Membership Dues are $20.00.

*Last Name *First Name M.I.  

*Home Address

*City *State *Zip Code  

*Telephone # Cell Phone # Pager #

*E-Mail Address

*Send Any Mail to My: Residence E-Mail Address Both

*How were you referred to HISLEA:

    Friend   Internet    Advertisement   Other

ACTIVE/REGULAR/HONORARY MEMBERS Fill Out The Following Only

*Law Enforcement Agency

*Position/Title *Star/ID#

*Work Phone #  

 

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