Membership Application
FLORIDA LAW ENFORCEMENT CANINE ASSOCIATIONAPPLICATION FOR YEAR 20_
(CIRCLE ONE)
NEW MEMBERSHIP/RENEWAL MEMBERSHIP
NAME_______________________________________________________
ADDRESS____________________________________________________
CITY_____________________STATE_______ZIP__________________
K9 NAME________________________AGE_____BREED____________
AGENCY___________________________RANK___________________
YEARS OF K9 EXPERIENCE______________________
AGENCY ADDRESS________________________________________
CITY______________________STATE_______ZIP_____________
PHONE(HOME)__________________WORK______________________
PAGER___________________________ E-MAIL_____________________
TYPE OF MEMBERSHIP
(CIRCLE ONE)
K9($35.00)-------ASSOCIATE($35.00)($10.00 LATE FEE AFTER FEB28)
CERTIFICATION
(CIRCLE EACH APPLICABLE)
PATROL----- ----NARCOTICS—EXPLOSIVE----TRACKING
($20.00 FEE FOR EACH OF CERTIFICATION)
TAX ID: 20-5816993
SEND CHECK OR MONEY ORDER TO:
Florida Law Enforcement Canine Association Inc.
P.O. BOX 210757
ROYAL PALM BEACH, FL 33421-(0757)
