National Black Police Association
30 Kennedy  Street, N.W. Suite 101
Washington, DC 20011
(202) 986-2070     (202) 986-0410 FAX

INDIVIDUAL MEMBERSHIP APPLICATION
$100.00 per person (due by January 31 annually to be financial and in Good Standing)
NAME
 
HOME
ADDRESS		 
POLICE AGENCY 
WORK ADDRESS 
ACTIVE/
UNIT ASSIGNED []		 
RETIRED []
(YEAR/RANK/YRS EXP)
 		 
DAY
PHONE		 
NIGHT PHONE 
FAX 
E-MAIL 
LAW ENFORCEMENT ORGANIZATIONAL AFFILIATIONS
(Name and Position Held)
 

 

TEACHING CREDENTIALS/EXPERIENCE
(Curriculum/Course Description)