O H I O L AW E N F O R C E M E N T K 9 A S S O C I A T I O N “To improve K-9 use, training and confidence by forming partnerships from multi jurisdictions around the state."
Canine Legal Updates-Instructor Terry Fleck November 18, 2009 Great Wolf Lodge Mason, Ohio REGISTRATION FORM
NAME:
DEPARTMENT:
DEPARTMENT ADDRESS:
DEPARTMENT PHONE NUMBER:
DEPARTMENT FAX NUMBER:
E-MAIL ADDRESS:
K-9 NAME: BREED:
SHIRT SIZE:
3 XL 2 XL XL L M S
REGISTRATION FEE: $130.00 Non-OLEKA Member (Includes Membership) $10000 OLEKA Members
Please make checks payable to: OLEKA “TOP DOG” Attn: Gerald Bemis P.O. Box 104 New Lebanon, Ohio 45345
SUBMIT REGISTRATION & FEES NO LATER THAN November 10, 2009.
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Dear Participant,
Please fill out this packet in its entirety to ensure acceptance into the competition. All packets must be received by the date listed.
You can join OLEKA on site prior to the start of the seminar.
If you have any questions please send inquiry to [email protected].
Send all packets by their listed deadline to:
OLEKA P.O. Box 104 New Lebanon, Ohio 45345
Sincerely, Gerald Bemis
Gerald Bemis President Ohio Law Enforcement K9 Association
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Photo Release Form
During attendance of this OLEKA K9 competition, staff members will be taking photos for future OLEKA presentations and promotions. All photos and video will contain the utmost professionalism and will project the quality course desired by OLEKA.
By signing this form you are releasing all photos and/or video that are taken during your attendance of the OLEKA certification and further give permission for staff to use that acquired media in manners conducive to the mission of OLEKA and its promotion.
Print Name
Signature
Date
P . O . B O X 1 0 4 • N E W L E B A N O N , O H I O • 4 5 3 4 5 P H O N E : 9 3 7 - 6 8 7 - 1 4 7 6 O H I O L AW E N F O R C E M E N T K 9 A S S O C I A T I O N “To improve K-9 use, training and confidence by forming partnerships from multi jurisdictions around the state." INVOICE
Place a check next to the option you are submitting this packet for. NOTE: Only one checkmark per packet November 18, 2009 Canine Legal Updates Instructor Terry Fleck Deadline November 10, 2009
OLEKA Member $100.00 Non OLEKA Member (Includes one year membership) $130.00
First Name: Last Name:
Office Name: Title: Street Address: City: State: Zip-Code: Phone Fax Number: Number: Payment Check Number/Purchase Order Number:
P . O . B O X 1 0 4 • N E W L E B A N O N , O H I O 4 5 3 4 5 P H O N E : 9 3 7 - 6 8 7 - 1 4 7 6 OhioOhio LawLaw EnforcementEnforcement K9K9 AssociationAssociation MEMBERSHIP APPLICATION Annual Dues: Regular $30.00 and Associate Members - $30.00 per Year
Today's Date: ______/______/______Date of Birth: _____-_____-_____ Last Name: ______First: ______MI: Home Address: ______City: ______State: ______Zip: Home Phone Number: (area code) ______-______-______Email ______Type of membership Regular Active Associate ************************************************************************************************************************************************************ Answer ALL questions. Are You a Certified Law Enforcement Officer? Yes___ No___
If yes: State Federal Local Fire/Investigator EOD Do you have Arrest powers? Yes___ No___ Does your Law Enforcement Employer use you and the K9? Yes___ No___ Police/Law Enforcement Agency Employed by: ______Work Address: ______City: ______State: Zip: Work Phone Number: (area code) ______-______-______Email ______Position (circle one): Handler, Trainer, Other - describe: Narcotics Explosives Patrol Accelerant S&R ************************************************************************************************************************************************************ Associate Member Indicate type of Associate Out of State Law Enforcement K9 Out of State Law Enforcement non K9 In state Law Enforcement non K9 Emergency Responder Private for hire K9 handler In State non Law Enforcement non K9 Regular Member signature sponsoring you: ______If you have no sponsor leave blank. Regular Member - print your name here:______************************************************************************************************************************************************************ K9 Information K-9's Name: ______Date of Birth: _____-_____-_____ Age: ______yrs. ______months Sex: M F Breed: ______Color(s): ______************************************************************************************************************************************************************ NOTE: All personal checks that do not clear will be charged a $30.00 fee in addition to membership fee and any bank fees you may incur. All applications are subject to background check for authenticity and integrity. By submitting this application you agree that all information is correct and truthful to the best of your knowledge.
(Applicant Signature) Send Membership form and fees (payable OLEKA) to:
Ohio Law Enforcement K9 Association P.O. Box 104 New Lebanon, Ohio 45345
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