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I.U.P.A. Local 5220
Virginia Troopers Alliance
Active Membership Insurance Forms
The form below must be filled out by Active Members to ensure coverage and verify beneficiaries. Send the completed form to the VTA at P.O. Box 462 Yorktown, VA, 23690. We will forward the form to the insurance carrier. The cost for the below coverage is included in the monthly dues and is at no additional cost to Active Members. Active Members must fill out the below form for the coverage to begin. If you have questions about the insurance coverage or if you wish to expand the insurance coverage contact the VTA.
If you cannot print a copy of the below information by resting the mouse pointer on the picture and a print icon appearing, e-mail the VTA and we will send you a copy of the insurance form as an e-mail attachment.
Please do not print or copy VTA forms on state owned equipment.