Membership Form

international police association canada section
Membership Application Form

* Indicates required field

Select One *

Current Membership Number (if applicable) *

First Name *

Middle *

Surname *

Date of Birth *

Street Address *

Postal Address (if different) *

City *

Province *

Postal Code *

Email *

Phone Number *

Alternate Phone Number *

History of Law Enforcement Service i.e. Police Service/Other Agency, Date employed, Date retired, Rank *

Tell us about yourself. List other languages, special skills, hobbies, interests. *

Name of Spouse / Companion *

Can you host visitors? *

Children (names & ages if under 18) *

Declaration / Déclaration:
I hereby agree to abide by the rules of the International Police Association as laid down in the Constitution of the Canadian Section.

I hereby authorize an IPA Representative to confirm my law enforcement service listed above.

I hereby authorize an IPA Representative to contact me to collect annual membership dues ($35/year)

I release any individual or agency from any liability as a result of providing such information.

I wish to apply for membership in the International Police Association.

I authorize IPA Canada and IPA Canada Region 3 to send me email material related to IPA activities.

Acceptance *

I accept and wish to apply for membership I do not accept at this time

Upload Passport Photo *

Max file size: 20MB

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international police association canada sectionMembership Application Form

international police association canada section
Membership Application Form