Application Date

Please Type

Application Date: / / Applicant Information Last Name First M. Initial Home Phone No. Pager or Cell Phone ( ) - ( ) - Street Address City State Zip Code E-Mail Address

K9 Information Breed Name Age

Agency Information Agency Name Current Rank

Street Address City State Zip Code Work Phone No. ( ) - Officer Status Handler K-9 Unit Supervisor Trainer Past Handler Officer/Non K-9 Examiner K-9 Certifications Patrol Narcotic Det. Explosive Det. Arson Cadaver Search & Res. Bloodhound Other Fees Check# Money Order# Cash Amount Total Amount Sent $35/Year – Full Membership ( Handlers, Trainers, Admin)

$175/Lifetime – K-9 Career Membership (Working Career Of K-9) Make Checks Payable to “C.P.W.DA.” Delivery Address Mail checks to:

James A. Cortina Treasurer C.P.W.D.A. 596 Vauxhall St. Ext. Waterford, CT. 06385

BY-LAWS, ARTICLE 9, SECTION - A DUES MUST BE POST MARKED OR HAND DELIVERED NO LATER THAN FEBRUARY 1, 2017 TO AVOID A $20.00 LATE FEE. NO CERTIFICATION TESTING WILL BE PROVIDED, UNLESS YOU ARE A CURRENT MEMBER IN GOOD STANDING. CERTIFICATIONS WILL BE INVALID IF MEMBERSHIP DUES ARE NOT CURRENT. ( BY-LAWS, ARTCLE 9, ) THOSE WHO DO NOT PAY THEIR DUES EITHER BY THEMSELVES OR BY THEIR P.D. BY FEBRUARY 1, 2017 WILL NOT BE ELIGIBLE FOR FREE SCHOOLS OR PARTIAL PAYMENT.