National Police Canine Association
Membership Application
Application for Month___________ year 20___ State:____
___ New Membership
++check one ++
___ Renewal Membership
NAME:_________________________________________________________________
MAILING
ADDRESS:_____________________________________________________________
CITY:__________________________STATE:_____________ZIP:________________
K-9’s NAME:____________________________AGE:_____BREED:______________
AGENCY:____________________________________RANK:____________________
YEARS OF K-9 EXPERIENCE:___________________________________________
AGENCY ADDRESS:____________________________________________________
CITY:_________________________STATE:_____________ZIP:_________________
PHONE: (home)__________________________(cell)___________________________
E-MAIL
ADDRESS__________________________________________________________________
**(to receive electronic voting and access to talk group: NPCA@yahoogroups.com)***
Type of Membership
(circle one)
Regular K-9 ($40.00)++++Associate ($40.00)++++Support ($200.00)
Individual Corporate($50.00)++++Business Corporate($100.00)
__________________
($10.00 Late Fee for Renewals After February 28)___________________________
Certifications are $20.00 each
(please mark all that you are certifying in)
_____Narcotics_____Patrol_____Human Concealment ______Handler Protection
_____Explosives_____Tracking_____Trailing_____SRT______Gun______Currency
Please type or print application so that it is readable, otherwise it can not be processed.
For further information please contact via www.NPCA.net or 1-877-362-1219.
APPLICATION MUST BE COMPLETE AND SUBMITTED WITH DUES
Forward to:
N.P.C.A.
Katy Farnsworth
P.O. Box 538
Waddell, AZ 85355
22