2016
Missouri Police Canine Association
2016
2016 Membership dues of $30.00 are due January 1, 2016. Dues are delinquent after April 1, 2016.
After April 1, 2016 Dues are $35.00. New Members only pay $30.00.
Date
New Applicant
Name
Annual Renewal
Phone
Handler
Home Address
City
State
ZIP
E-mail Address (required for certifications)
Department
Dept.
Phone
Dept. Address
City
State
ZIP
K9
K-9 Name
Age
Breed
K-9 Color
Dual Purpose
Dues:
Cash
Protection
Check #
Narcotic
Explosives
Regular Member
Tracking
Cadaver
Associate member
MAKE CHECKS PAYABLE TO MISSOURI POLICE CANINE ASSOCIATION
Please make sure to remit form and payment to the correct address.
Our address changed in 2015 and your department may have the wrong address in their system.
(Application form must accompany check)
Mail to:
Chris Smith
19951 Porter Rd.
Clark, MO 65243
1-573-256-7648
President: Mike Perkins