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MCOPA Membership Application

Date

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Full Name(*)
Please enter your name.

Type of Membership(*)
Please select membership type.

Title
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Police Department/Agency (Sanford Police Department) (*)
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Agency Address (street #, street, city, state, zip)(*)
Please enter address.

Residence Address (street #, street, city, state, zip)
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Send Maile To(*)
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Office Phone Number(*)
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E-Mail Address(*)
Please check email address.

Place of Birth
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Date of Birth

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Name of Spouse
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Education Summary
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Date elected or appointed to present office.(*)

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Law Enforcement Experience (with approx. dates)(*)
Please enter your experience.

Have you previously been a member of the MCOPA (check one)(*)
Have you previously been a member of the MCOPA (check one)

If so, when and where
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Applicant's Initials (enter)(*)
Initials

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)
Enter sponsor name.

Sponsor Agency
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Sponsor City
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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)(*)
Please initial 2nd box.

Maine Chiefs of Police Association

Post Office Box 2431
South Portland, ME 04116-2431

Call: 207-799-9318

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