VIRGINIA POLICE CANINE ASSOCIATION

                                   Membership Application 2009

Name:  ___________________________________   

Title:  _________________________

Department:  ______________________________ 

Department Phone #:  ____________

Department Address:    _____________________________________________

                                   _____________________________________________

                                   _____________________________________________

Years of Service:  _________ 

E-mail Address:  __________________________________

Home Phone:  _________________________ 

Cell Phone: ________________________

Master Trainer:  __________  Trainer:  _________  Handler:  ___________

K-9 Supervisor:  __________  Decoy:  __________ 

K-9 Name:  _______________  Breed:  ________________ 

K-9 Age:  ___________

Patrol:  ________  Narcotics:  _________  Explosive:  _________ 

SAR:  __________

Accelerant:  _________  Cadaver:  _________  Wildlife:  _________

Please note any previous schools or training: 






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Please make check payable to VPCA in the amount of $35.00 and mail to the following address:

                                                      VPCA
                                             C/O Chad Brubaker
                                             78 West Lee Street
                                           Warrenton, VA  20186