TCSLEA
Membership Level

Not every blank will apply to you, but please fill out as many as possible. This information will be saved in a secure area to process your application. Erroneous or missing information may cause additional delays.

If you are unable to complete the online application, or need assistance with the online application, Marc Taub (West Command, Mon-Thur normal business hours) is able to assist you.

** Denotes required fields.

Member Information

Employee Number
First name:**
Last Name:**
EIN:

Email Address:**

(NOT COUNTY EMAIL)

Street Address:**
City:**
State:**
Zip:**
DOB (MM/DD/YYYY):**
Home Phone:
Cell Phone:

Work Information

Work Location:**

Dues Per Pay Period

TCSLEA Price $10.00 ***Applied to all memberships
Legal Defense:** (Choose one)

Keel & Nassour $7.50


None $0.00 By selecting this, I voluntarily opt out of the legal defense plan at this time.

PAC:**

(Total Donation Amount)

$0 if none

Memorial Fund:**

(Total Donation Amount)

$0 if none

Note: there is no requirement to donate monies to the Political Action Committee (PAC) or to the Memorial Fund.

Your decision to contribute to either is strictly voluntary and without regard to your status as a member of the Travis County Sheriffs' Law Enforcement Association.

Please make a note of your personal deductions per pay period.

Other

TCSOA: Check if applicable  I am currently a member of the TCSOA, and wish to CANCEL that membership.
Referred by:
Optional Comments:
Signature:**  My signature (or electronic approval) certifies all information as entered on this application is accurate and complete to the best of my knowledge.

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