Date Month January February March April May June July August September October November December Select One Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Select One Year 2010 2011 2012 2013 2015 Select One
Your Full Name (Jones, Peter)
Type of Membership Regular Member Associate Member Corporate Associate Life Member Other Please choose one...
Title
Police Department/Agency (Sanford Police Department)
Agency Address (street #, street, city, state, zip)
Residence Address (street #, street, city, state, zip)
Send Mail To: (check one) Business Residence
Business Phone
Email Address (jones@aol.com)
Place of Birth
Date of Birth
Name of Spouse (optional)
Education
Date elected or appointed to present office
Law Enforcement Experience (with approx. dates)
Have you previously been a member of the MCOPA (check one) Yes No
If so, when and where
Applicant's Initials (enter)
By entering your initials you certify that the information in this application is true and correct to the best of my knowledge and belief. Any false information or misstatement of fact could result in refusal of this application or removal from membership in the Maine Chiefs of Police Association.
Sponsor Name (must be sponsored by current member)
Sponsor Agency
Sponsor City
All applicants must be sponsored & investigated by a current and regular member of the MCOPA. Sending and completing this application does not guarantee membership in the Maine Chiefs of Police Association.
I have read and understand the above statement (please initial)
