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 x411Name* First Middle Last Membership Type* Sworn Civilian Retired Associate Name of Business* Website* Badge Number*District/Assignment Date of Birth* MM slash DD slash YYYY Email 1* Email 2 Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Primary Phone*Other PhoneSurvivor 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:*NamePercentagePhoneEmailDate of BirthRelationship (Use the plus sign to the right of the 'Relationship' field to add additional rows for more beneficiaries)Contingent Beneficiaries:NamePercentagePhoneEmailDate of BirthRelationship *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.Upload your form Drop files here or Select files Max. file size: 50 MB. NameThis field is for validation purposes and should be left unchanged. Δ
