CPOMA APPLICATION FOR AFFILIATION

Date:________________________

Name of Organization/Department/Union/Other:_________________________________________

Principal Contact (s):________________________________________________________________

Address:___________________________________________________________________________

City:___________________________                                    Province/Territory:_________________

Postal Code:_____________________

Telephone:______________________                                    Fax:_____________________________   

Representing members in which Peace Officers' community?

__________________________________________________________________________________

Approximate number of Peace Officers:_________________

Signature:_________________________________________

For copy of Application Form, please refer to contact numbers on Home Page.  Once received, the CPOMA Board of Directors will review at the next meeting.