Membership Application

If you have any questions, we can answer them for you. If you’d like to speak with a real person. You can reach Colleen Girard, she's the Executive Secretary for AZTroopers. You can email her at colleen.girard@aztroopers.org or call her at 888.291.6551 x411

Name*

First Middle Last

Membership Type*

Sworn
Civilian

Name of Business*

Website*

Badge Number*

District/Assignment

Date of Birth*

Email 1*

Email 2

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Primary Phone*

Other Phone

Survivor Benefits

*In this section, please identify the beneficiaries of your survivor benefits offered with association membership. This benefit is null and void if no beneficiary is assigned. It is the member’s responsibility to make sure this information is correct and updated in a timely manner. We cannot accept a child under the age of 18 or a family trust as the beneficiary for this member benefit.

Primary Beneficiaries:*

Name	Percentage	Phone	Email	Date of Birth	Relationship

(Use the plus sign to the right of the 'Relationship' field to add additional rows for more beneficiaries)

Contingent Beneficiaries:

Name	Percentage	Phone	Email	Date of Birth	Relationship

*If no percentages are indicated, the benefit will be divided equally among other beneficiaries of the same class. If any beneficiary predeceases the member, that beneficiary’s share will be divided equally among the other surviving beneficiaries of the same class. If no beneficiary survives the member, funds will transfer back to the association.

Confirmation*

I hereby designate the above persons as the beneficiaries for my association member survivor benefit.

Additional Form Please download this document and fill it out properly and sign it. Then scan it into your computer as a PDF and upload it along with this form using the button below. Payroll Deduction Form (only Sworn/Civilian Members) *If you have any issues and are not able to upload the form, please click here to email it to colleen.girard@aztroopers.org and attach it to the email manually.

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