CPICA Membership Application Form

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Print and mail this form to:

CPICA
c/o Bob Pyefinch, 201 Fulford Point Rd., Elizabethtown, Ontario K6V 7E1 CANADA

Name  
Address  
City  
Province  
Postal Code  
Telephone  
Employer or Police Department  
Rank or Occupation  
Recommended by:  
Date of Application:  
I am interested in collecting:  

 

 [    ] Shoulder Patches
[    ] Metal Badges
[    ] Other
Email:  
Homepage:  

I have enclosed my membership dues to keep me in good standing for now until January of next year. My membership dues enclosed are $20.00 North American or $25 International in the form of:

[    ] Cheque
[    ] Money Order

made out to Bob Pyefinch.

I understand that I will be sent a membership list and the issues of the Association Newsletter printed this calendar year. I understand that I will be guided by any by-laws that the Association has at present or institutes in the future.