PO Box 444
Derby, NY 14047



NYSPOA - Membership Form

We have now made it easier to renew or join NYSPOA online. If you want to join or renew using Pay Pal, please use the below form. If you would prefer to mail in your payment, please click here to print out your form.

Please provide the following information:

First Name
Last Name
Street Address
Address (cont.)
County   Region
Title   Years in Probation?
Phone Work Home Cell
I would like to receive the NYSPOA Newsletter by:
  US Mail   Email     (please choose only one)

I think NYSPOA'S priority should be:

Please Select items you are paying for below:

Active Member - $30 Dues
Active Member Renewal for 2 Years - $60 Dues
Administrative Member - $15.00 Dues
Associate / Student Member - $15.00 Dues
Retiree Member - $15.00 Due
Administrative, Associate, Student or Retiree Renewal for 2 Years - $30 Dues
Honorary Member - No Dues
Life Member - No Dues

Payment adjustments:
If you have a payment that does not fall in the above amounts, you can add them to your cart as well.
$15.00 for:
$30.00 for: Two Year Administrative, Associate, Student or Retiree Renewal
$60.00 for Two Year Special Rate Active Member

Once you hit "Submit Total and Pay with Pay Pal" below, you will be taken to a page to make your Pay Pal Payment.


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