Membership Form

International Police Association Canadian SectioN
Membership Application form

* Indicates required field

Select One *

Current Membership Number (if applicable) *

First Name *

Middle *

Surname *

Date of Birth *

Street Address *

Postal Address (if different) *

City *

Select One *

Postal Code *

Email *

Home Phone Number *

Alternate or Cell Number *

History of Law Enforcement Service i.e. Police Service/Other Agency, Date employed, Date retired, Rank *

Name of Spouse/Companion *

Children (names & ages if under 18) *

Tell us about yourself. List other languages, Special skills/Hobbies/Interests *

Username(s) (optional) *

Passport Photo *

Max file size: 20MB

Declaration

I hereby agree to abide by the rules of the International Police Association as laid down in the constitution of the Canadian Section.
I wish to apply for membership in the Canadian Section of the International Police Association and have included a payment of

Choose One *

35$/ 1 year 70$/2 years 100$/3 years

Name and Date *

Recommended by (Include Name, Section and Region) *

Proof of Service *

Max file size: 20MB

FOR OFFICE USE ONLY

Date Accepted *

IPA # *

Type of Membership *

Date Passport Issued *

Submit

International Police Association Canadian SectioNMembership Application form

International Police Association Canadian SectioN
Membership Application form