Complete this form, print it, and mail it with payment to:
HAPDA, PO Box 885, Salina, Kansas 67401
Certification/Membership Application
Applicant Information
Name
Address
Phone
Agency
E-Mail
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Canine Information
Trainer
Breed
Check the areas that you will attempt to certify in:
Patrol
Narcotics
Explosives
Mantrail
Arson
Do you intend to participate in the Trophy Dash?
$35.00 Annual Membership. $50.00 Certification Fees. (Membership runs from October to October)
Please choose
Amount Enclosed:
Invoice #
I do hereby release the Heart of America Police Dog Association and any persons working under said association from liability, and will assert no claim against said person(s) and /or association for any loss, damage. or injury caused or contributed by said canine(s) and/or person(s).
Signature _______________________________________ Date______________________
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