Associate Membership Application
Print this form and return via mail or fax to us with this Associate Membership information.

Indiana Troopers Association, Inc.

PO Box 798

Angola, IN 46703

Fax (260) 624-2747

YES! I want to be an Associate Member!
Name
Address
City
State
Zip
Phone
Fax
E-Mail
Affiliation with troopers
Credit Card Number Circle: Visa Mastercard Discover
Expiration Date
Please Select One

$25 Silver Associate Member

$50 Gold Associate Member

$100 Platinum Associate Member

$250 Diamond Associate Member

ITA SY Fund (Fully Tax Deductible Donation)


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Associate Membership materials will be sent upon confirmation.
If you have any questions or comments please contact us at 1-800-671-9851

Revised: March 15, 2007