BPAUX Membership Application

BORDER PATROL AUXILIARY MEMBERSHIP FORM

First Name

Middle Name

Last Name

Social Security Number (Optional)

Date Of Birth (Month, Day, Year)

Current Street Address

Current City

State

Zip Code

Regular Phone Contact Number

Emergency Phone Contact Number

Your Email Address, Not a friend
(you cannot share email address among members)

Backup Email Address Contact

Number of years at current address

Best time to contact you

What is Your Occupation now?

If you are retired, what field were you employed in?

If you have a CCW permit please list what state
and the expiration date

If you have been in the military or law enforcement,
please list what you did and where and when it was.

List any special skills you may have that can benefit BPAUX.

Are you interested in a BPAUX leadership role at this time,
and if so what skills, experience, background qualifies you for a leader.
Current Skills
Previous Military Background

Signature & Date In Box

Do you have any friends that might want to join BPAUX? Yes
No
Not at this time

Are you interested in creating a BPAUX group in your area?

Are you going to pay your dues via PayPal now?
We cannot process your background check without your dues paid.
Yes
No
Not at this time

Do you understand we cannot process your application without your dues paid ? Yes
No

We will not send this information to anyone outside BPAUX
create web forms

First Name
Middle Name
Last Name
Social Security Number (Optional)
Date Of Birth (Month, Day, Year)
Current Street Address
Current City
State
Zip Code
Regular Phone Contact Number
Emergency Phone Contact Number
Your Email Address, Not a friend (you cannot share email address among members)
Backup Email Address Contact
Number of years at current address
Best time to contact you
What is Your Occupation now?
If you are retired, what field were you employed in?
If you have a CCW permit please list what state and the expiration date
If you have been in the military or law enforcement, please list what you did and where and when it was. List any special skills you may have that can benefit BPAUX.
Are you interested in a BPAUX leadership role at this time, and if so what skills, experience, background qualifies you for a leader.	Current Skills Previous Military Background
Signature & Date In Box
Do you have any friends that might want to join BPAUX?	Yes No Not at this time
Are you interested in creating a BPAUX group in your area?
Are you going to pay your dues via PayPal now? We cannot process your background check without your dues paid.	Yes No Not at this time
Do you understand we cannot process your application without your dues paid ?	Yes No
We will not send this information to anyone outside BPAUX	create web forms