WSPSA Form

WSPSA Enrollment Form
Employee Full Name*

First NameLast Name
Employee E-mail*
example@example.com
Employee Work Phone Number*
Employee 8 Digit Personnel #*
District / Division / Section*
Are you fully commissioned?*

YesNo
Spouse Information*

Yes, I have a spouse (Please fill out their information below)No spouse (Thank you for your support)
Spouse Birthdate

MonthDayYear
Date
Spouse Full Name

First NameLast Name
Spouse E-mail
example@example.com
Spouse Phone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Deduction is $5 per payroll cycle/$10 per month.

Effective on the next available payroll cycle, by submitting this form, I hereby authorize a deduction of the amount entered above, per pay period, to be forwarded to the account of the Washington State Patrol Spouses Association until cancelled in writing or superseded by filling this form out again, or in writing to Budget & Fiscal Services.

Alternative payment can be made via PayPal annually for $120/year. wspspouse@gmail.com
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WSPSA Enrollment Form