Nevada Police Union Membership Application
Formerly known as Nevada Highway Patrol Association or NHPA, the Nevada Police Union represents state police officers and public safety employees within the Nevada Department of Public Safety, Nevada Department of Wildlife, Nevada State Parks, and the Nevada System of Higher Education.
Email *
First Name *
Last Name *
Personal Mailing Address (include street, city, state, and zip code): *
Phone #: *
Date of Birth (mm/dd/yyyy): *
Gender *
Marital Status *
Personal Email: *
Employee Status: *
Division: *
Job Title: *
Duty Station: *
NEATS #:
Social Security #:
Electronic Signature for Authorization
I understand that this application in the Nevada Highway Patrol Association (NHPA) authorizes NHPA to represent me in the matters pertaining to my employment with the State of Nevada. I hereby authorize the payroll department to deduct from my salary the membership dues in effect at this time or as modifies in the future. This authorization will remain in effect until canceled by me or by the NHPA. NAC281.260, as amended and adopted February 4, 2004, provides that a state employee may only cancel a payroll deduction request within the two weeks directly preceding the anniversary date when they initially requested payroll deductions.
Enter your full name to authorize: *
Enter today's date: *
MM
/
DD
/
YYYY
Enter the time: *
Time
:
Referred by:
Privacy Policy
Membership into the Nevada Police Union (formerly know as Nevada Highway Patrol Association) is administered by its executive leadership team and government affairs partner TriStrategies, LTD. Your information is protected and will only be shared with the State of Nevada human resources staff for the purpose of enrollment into the Nevada Police Union. If you have any questions, please call Union President Matt Kaplan at (775) 351-9396 or email president@nevadapoliceunion.com. For more information about the Nevada Police Union, please visit NevadaPoliceUnion.com
Submit
Never submit passwords through Google Forms.
This form was created inside of Tri-Strategies. Report Abuse