NCPOA APPLICAITON FOR MEMBERSHIP
Please complete application and return it with a check for membership to : NCPOA
Full Name:_________________________________________________________________
Home Address :________________________________________________________________
Business Address:_____________________________________________________________
Telephone: Home: ( )________________________ Business ( )__________________
E Mail Address______________________________________________________
Employed By (Law Enforcement Agency): ___________________________________________
Please submit a copy of your department issued active or retired identification card.
Position, Rank or Title:__________________________________________________________
If retired check: ___ Agency retired from: ________________________________________
Spouse:______________________________________________________________________
Sponsor____________________________________________________________________
Current members will be given credit for sponsoring a new member.
Associate only: Justification for sponsorship ________________________________________
_____________________________________________________________________________
Signature: ___________________________________________ Date:____________________
For Non-Law Enforcement Applications Only: The NCPOA has traditionally been for active and retired law enforcement and public safety members. However, non-law enforcement applications have been accepted from individuals that have distinguished themselves for being supporters of law enforcement.
ALL DUES ARE JULY 1ST to JUNE 30TH EACH YEAR
Dues: Active Members-$25.00 Annually ; Associate Members-$25.00 Annually ;
Life Membership $300.00
