Membership Registration Form

2022 MCPA Membership Form

Can't pay online? Print, then mail your check and completed form to: MCPA 13570 Grove Drive, #141 Maple Grove, MN 55311 (checks made payable to MCPA)
Name*

First NameLast Name
Title*
Agency*
I certify that I work for a Police Department:*

SwornCivilian
Address:*

Street Address

Street Address Line 2

CityState

Zip Code
E-mail*
Phone Number:*

Area CodePhone Number
Supervisor's Name*

First NameLast Name
Supervisor's E-mail*
example@example.com
Number of Officers *
Please write the number of sworn officers (authorized strength) for your dept.
Comments or Questions?
Special Skills (Optional):
Payments are processed through PayPal. You may pay using an existing PayPal account, or click the black "Debit or Credit Card" button to use any major credit card/debit card. Use coupon code EARLY to get a discount for registering before 3/15/2022

Invoice or Credit Card?

Individual Membership (Annual) $60.00

Individual Membership INVOICE$ Free

Select this option if you need to be invoiced for payment. Click the black "debit or credit card" button to submit your membership.

Enter coupon

Total $0.00

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2022 MCPA Membership Form