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APPLICATION

NAME:_____________________________    TITLE:_______________________________

AGENCY NAME:____________________________________________________________

AGENCY ADDRESS:_________________________________________________________

CITY/TOWN:_______________________________ STATE:________ZIP:_____________

BUSINESS PHONE: (____)__________________  FAX: (____)_______________________                                      

HOME ADDRESS:___________________________________________________________

CITY/TOWN:_______________________________ STATE:________ ZIP:____________

HOME PHONE: (____)__________________     E-MAIL:__________________________

MAILING PREFERENCE:   HOME______  OFFICE ______  FAX______

TYPE OF MEMBERSHIP: (Circle)  Active     Associate     Corporate     Affiliate     Agency                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                

CURRENT CRIME PREVENTION ACTIVITIES:________________________________

____________________________________________________________________________ 

 1.  Have you attended the New York State Basic Crime Prevention School? Yes__  No__

     If yes,  where and when?______________________________    Hours attended:______

 2.  Sponsor Requirements/Name(s):  Associate- 1 active member; Affiliate- 2 active members; Agency- 1 active member; Corporate- 2 active/associate members

NAME:__________________________________

PHONE:_________________________________AGENCY:_________________________

NAME:__________________________________

PHONE:_________________________________AGENCY:_________________________

   RETURN APPLICATION (with appropriate dues) to:

 CPA WNY C/O the Office of Public Safety

71 Eastwood, Lower, Buffalo, NY 14208

Memberships 

Active Member  ($25 Annual Dues)

1.     An Active Member shall be a current or retired Police Officer (Peace Officer) as     defined by the Criminal Procedure Law of New York State.

2.     An Active member shall be responsible to carry out the mission and objectives of the Association.

3.     An Active Member shall have voting rights, may serve on committees, is eligible to hold office, must be a U.S. citizen and a WNY resident.

Associate Member  ($25 Annual Dues) 

1.     An Associate Member must be actively engaged as a crime prevention practitioner and must exhibit an interest and desire to foster the mission and objectives of the Association.

2.     Associate Members must be sponsored by one Active Member in good standing and approved by a majority vote of the Board of Directors.

3.     An Associate Member shall have voting rights, may serve on committees, is eligible to hold a Trustee position, must be a U.S. citizen and a WNY resident.

 Agency Member  ($75 Annual Dues)

1.     Agency Membership may be granted to law enforcement and non-profit organizations (501 C3), community-based organizations or neighborhood crime prevention programs which exhibit an interest and desire to foster the mission and objectives of the Association.

2.     Agency Members must be sponsored by one Active Member in good standing and approved by a majority vote of the Board of Directors.

3.    Agency Members may serve on committees and shall have one vote collectively per Agency.

 Affiliate Member  ($25 Annual Dues)

1.     An Affiliate Member is one who displays an interest and desire to foster the mission and objectives of the Association.

2.     An Affiliate Member must be sponsored by two Active Members in good standing and approved by a majority vote of the Board of Directors.

3.     An Affiliate Member shall have voting rights an may serve on committees. 

Corporate Member  ($125 Annual Dues)

 1.     Corporate Membership may be granted to corporations or businesses, who have shown an interest and desire to foster the mission of the Association.

2.     Corporate Members must be sponsored by two Active or Associate Members in good standing and approved by a majority vote of the Board of Directors.

3.     Corporate Members may serve on committees and shall have one vote per corporation.