Application/Dues

Primary Member First Name

Primary Member Last Name

Class #

Primary Member Email

Primary Phone

Street, City, State, Zip Code

COUPLES MEMBERSHIP

Complete section below only if you and your spouse/significant other successfully completed the

Citizens Police Academy and both are becoming members of the GPCPAAA.

Secondary Member First Name

Secondary Member Last Name

Class #

Secondary Member Email

Secondary Phone

Street, City, State, Zip Code

Select One

Single Membership - $15

Couple Membership - $20