"*Membership Application of the Hawaii Joint Police Association, a Non-Profit Police Enforcement Agency"

Category: Application	INITIAL RENEWAL CORPORATE YOUTH REGULAR
FEE: REGULAR $25 PER YR; CORPORATE: $150 PER YR; YOUTH: $5 PER YR
Name: (Last, First, M.I.):
Date of Birth: (yr, mo, day)
Spouse First Name:
Title or Military Rank:
Organization Name:
Address:
City:
State:
Zip:
Country:
Phones:
Office Phone:
Fax:
Preferred mailing address:
Email address:
Indicate here if it is OK to publish this information in HJPA Directory and on the web page: Yes No
If not OK, indicate what you will allow to be published;
Brief Biography:
HJPA Badge: A photo badge will be issued by Security Resources.� Please email a digital picture suitable for an ID badge to HJPA for processing.� You can also mail a regular photo along with your application and payment if you do not have access to a digital camera. Certification; I understand that the information contained herein is authorized to be published in the HJPA newsletter and directory, via electronic and hard copy means. I understand and agree that my membership in the HJPA may be terminated by action of the Board of Directors for cause which would be any action upon my part that is considered to be detrimental to the best interests of the HJPA. Any dues already paid will not be refunded.
Signature:
Nominated by:
Date of application:

*

Hawaii Joint Police Association
P. O. Box 19182
Honolulu, Hawaii 96817

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