Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Cell Phone Number *

Country

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*

I have read and acknowledge the contents of the New Member Agreement

If you were referred by a co-worker, please enter their name so they can receive proper credit.

Referred By

First Name

Last Name

Have you been involved in a 998 in the last year? *

Yes

No

Have you been involved in a CAT III UOF in the last year? *

Yes

No

Have you been advised that a POE has been filed against you in the last year? *

Yes

No

Have you been ROD in the last year? *

Yes

No

Have you been benched in the last year? *

Yes

No

Have you been placed on Performance Review or Peer Mentoring in the last year? *

Yes

No

Have you been involved in an on-duty TC in the last year? *

Yes

No

I have read and acknowledge the contents of the New Member Agreement

Rank: You Must Select One *

Deputy Sheriff—-$80

Sergeant—-$90

Lieutenant—-$100

Captain--$110

Custody Assistant--$60

Law Enforcement Technician--$50

Security Officer--$40

Security Assistant--$35

Professional Staff (varies by item number, please call LASPA office)

Sheriff's Reserve Deputy--$225 per year or $60 for 3 months

Other

Yes, I agree to the above terms and conditions.