Application

Membership Application

This form must be submitted for new memberships and renewals!

NAME:_____________________________________________ AGENCY:________________________________________

JOB TITLE:_________________________________________ E-MAIL:_________________________________________

SUPERVISOR:__________________________________________________________

MAILING ADDRESS:____________________________________________________

CITY:____________________________ STATE:________ ZIP CODE:_____________

PHONE: ( ______ )_______-____________ FAX: ( ______ )________-____________

DISCLOSURE OF MEMBER'S INFORMATION:

The information I have provided on this form can be distributed to other MARCAN members. (Circle One: Yes/No)

The information I have provided on this form can be displayed on the MARCAN website. (Circle One: Yes/No)

Signature:_______________________________________

LAW ENFORCEMENT ONLY INFORMATION: As a condition of membership to MARCAN, I agree that any Law Enforcement Sensitive information that I am exposed to, regardless of format or medium, shall be disclosed by me only as necessary to members of other law enforcement agencies. I have read the MARCAN bylaws (on website) and agree to abide by them.

Signature:_______________________________________

REQUIRED SUPPORTING DOCUMENTATION AND DUES

c Copy of employee photo ID (required)

c Letter from law enforcement agency verifying employment (NEW members only)

c Membership fees in the form of a check payable to MARCAN:

c New membership - $35 OR

c Membership renewal - $30 OR

c Please send me an invoice. (Registration will not be complete until invoice is paid.)

c Forward my registration information to I.A.C.A. (International Association of Crime Analysts) for membership (optional - no additional cost) - You are responsible for activating and maintaining your IACA membership at www.iaca.net.

Please mail this application, supporting documentation, and membership dues to:

MARCAN

ATTN: Kyle J. Stoker

P.O. Box 3262

Olathe, KS 66063

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NAME:_____________________________________________	AGENCY:________________________________________

JOB TITLE:_________________________________________	E-MAIL:_________________________________________

CITY:____________________________	STATE:________	ZIP CODE:_____________

PHONE: ( ______ )_______-____________	FAX: ( ______ )________-____________