NCPOA
NCPOA
NCPOA APPLICATION FOR MEMBERSHIP 

Please complete application and return it with a check for membership to :   NCPOA 
PO Box 983
Sloughhouse, Ca. 95683

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  or over age 60 and 5 years membership in good standing $200
Name tags are available for $8.00.     Life Member badges are complimentary.