National Black State Troopers Coalition Membership Application

The National Black State Troopers Coalition Membership Qualifications:

INDIVIDUAL:

Any State Trooper who is an active or retired member of a State Police, State Patrol, State Highway Patrol or State Department of Public Safety Agency and in good standing with their State Chapter, if one exist. Individual members must support the interest of furthering the goals and objectives of the NBSTC. * Return with $25.00 membership fee and copy of credentials

ASSOCIATE:

All individuals of any law enforcement agency who do not meet the qualifications for chapter membership(s) and who support the interest of furthering the goals and objectives of the NBSTC. An Associate Member may be elected to any office with the exception of the offices of President and Vice President. *Return with $25.00 membership fee and copy of driver’s license

ASSOCIATE BUSINESS MEMBER:

All civilian business community supporters interested in furthering the goals and objectives of the NBSTC. * Return with $75.00 membership fee and Business card.

Name *

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Rank:

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Address: *

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State Zip

Date of Birth: * +

Telephone home:

Cell:

Preferred Email Address *

Agency:

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Job Description, i.e. patrol, investigations, etc.:

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Instructor Certifications check here.

Instructor Certificate

Explain Instructor Certificate:

Work Address:

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State Zip

By applying for membership with the National Black State Troopers Coalition, Inc., I hereby agree to abide by the By-Laws and Constitution established by the N.B.S.T.C.

Signature of applicant: *

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National Black State Troopers Annual Dues *

An Online Convenience fee of .87 cents will be added to the Individual and associate members fees. And an Online Convenience fee of 1.99 cents will be added to the associate business member fee upon final transaction.

State Chapter Name, if one exist:

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Date: +

FOR OFFICIAL USE ONLY