First Name (required)

Last Name (required)

Middle Initial

Mailing Address (required)

Apartment (if applicable)

City (required)

State (required)

Zip (required)

Home Phone (required)

Business Phone/Cell Phone (required)

Email (required)

Employee ID Number (required)

Badge Number (if applicable)

Sworn or Civilian (required)

Date of Birth (required)

Law Enforcement Agency (required)

Duty Assignment (required)
(eg. Homicide, Northside District, etc...)

Classification (required)
(eg. Police Officer, Sergeant, Accountant, Secretary, etc...)

By typing your name below in the Signature field the applicant acknowledges the following terms:

"I'm interested in joining the Miami-Dade Hispanic Police Officers Association. Membership dues are $10.00 bi-weekly. However, I agree to set up monthly recurring payments of $21.67 via the secure paypal link that will be e-mailed to me upon review of my application. This amount shall be paid to the HPOA and represents payment of my dues. I understand that these deductions can only be terminated by giving the HPOA prior written notice as provided by law."

Signature (required)