Become A Member Application

Membership Payment Options

If payroll deduction is not available to you, we offer the following alternative options, available below:

Bank Draft (ACH)
By providing your checking account information, your monthly membership contribution will be securely drafted directly from your bank account each month.

Lump Sum Payment
Using a credit card, you may pay your membership contribution on a semi-annual or annual basis.

Monthly Subscription (PayPal or Credit Card)
Using your PayPal account or a credit card, you may set up a monthly recurring membership subscription that you can manage or cancel at any time.

Bankdraft/Lump Sum Application

You may donate through our bankdraft option by providing your bank account information and your donation will be deducted from your provided account on the 5th of every month (UNTIL YOU CANCEL). Or you may donate through our “lump sum” option by paying one lump sum per year, you will be sent a renewal via email or mail (your choice).

Step 1 of 2

Donation Type
Lump Sum Type

Renewing Member

New Member

Name(Required)
First Last
Last 4 SSN
Date of Birth(Required)
MM slash DD slash YYYY

Date of Hire(Required)
MM slash DD slash YYYY

Address(Required)
Street Address City State ZIP Code

Institution (Place of Employment)(Required)
Please put name of your institution/facility. NOT just Department of Corrections.
Institution State(Required)
Job Title(Required)
Employee ID#
Cell Phone(Required)
Email(Required)

Spouse (Person of Choice)
Referred By
Monthly Donation
Name on Account(Required)
First Last
Type of Account(Required)
Routing Number(Required)
Account Number(Required)
How would you like your renewal sent(Required)
Donation Amount(Required)
Donation Amount(Required)
Please select the amount you would like to donate monthly.
Total

Payment Method

MasterCard
Visa
Supported Credit Cards: MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Signature
Signature(Required)
Date(Required)
MM slash DD slash YYYY

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Monthly Subscription Membership

Step 1 of 2

Please complete this form to utilize our monthly subscription option for CPOF membership.

Name(Required)
First Middle Initial Last
Date of Birth(Required)
MM slash DD slash YYYY

Date of Hire(Required)
MM slash DD slash YYYY

Address(Required)
Street Address City State ZIP Code

Institution (Place of Employment)(Required)
Institution State(Required)
Job Title(Required)
Employee ID# or Social Security Number:(Required)
Cell Phone(Required)
Email(Required)

Spouse (Person of Choice)
Referred By
Monthly Donation
Donation Amount(Required)
After 6 months of membership at the $25 level, you are eligible for a membership gift. The membership department will contact you to confirm your choice.
Signature
Signature
Date(Required)
MM slash DD slash YYYY

Prior to submitting, please ensure you complete the subscription process utilizing one of the following links:
$5 member
$10 member
$25 member
$50 member

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Become a Member Application

Become a Member of CPOF today!

Payroll Deduction

Payroll Deduction Application or Request

Membership Payment Options

Bankdraft/Lump Sum Application

Monthly Donation

Signature

Monthly Subscription Membership

Monthly Donation

Signature