National Association Citizens On Patrol           P.O. Box 727, Corona, Ca 92878-0727
a non profit public benefit corporation                      Tel: 951-898-8551   Fax: 951-279-1915


Citizen Patrol Group Name:_________________________________________________________________________

Primary contact person or Coordinator:________________________________________________________________

Mailing address for sending information:_______________________________________________________________


Primary Telephone number we can call:_________________________________ Fax:___________________________

Primary e-mail address:____________________________________________________________________________

Existing Web Site Address (if applicable)______________________________________________________________

Contact person for your NACOP Web Site ___________________________________Telephone:_________________

Actual Number of Citizen Patrol volunteers currently in your group:__________________________________________

(Please Check the Below the Annual Group Rate you are Applying for)

                          _____ 1-25 $125.00   _____ 26-50 $175.00    _____ 51-75 $225.00    _____ 76-100 $275.00

Number of additional members above 100:__________ $50.00 fee for each additional 25 members over 100
Special Savings Offer:   Pay now for two years and receive the third year Free!

(Note: A master copy of the NACOP newsletter, "Eyes and Ears" will be sent each quarter to the Primary Contact Person listed above which may be reproduced for as many of your Citizen Patrol volunteers and department members as you wish)
Renewal Policy: Unless otherwise notified, we will automatically issue an invoice one month prior to the end of your annual term.

        Please select below one of the following which best describes your Citizen Patrol Organization:

_______Our group is funded by a Law Enforcement department and our members are LE volunteers
             If Yes, provide the name of your Law Enforcement department:_____________________________________
_______ Our group and members are funded by our city and are volunteers for a Law Enforcement department
             If Yes, provide the name of your Law Enforcement Department:_____________________________________
_______Our group is funded by our city and our volunteers are not Law Enforcement volunteers.
_______Our group is independently funded and is separate from our city and local Law Enforcement department.
_______Other: (Please Explain)________________________________________________________________

By joining the National Association Citizens On Patrol,  we understand that the NACOP does not directly endorse or represent any individual Citizen Patrol members or groups. Further, we do not endorse or represent any political activities, candidates, or specific law enforcement departments. The NACOP acts in the best interest of Citizen Patrol organizations and volunteers for the continued use and growth of these vital crime prevention organizations by providing a variety of services as outlined in the most current NACOP membership brochure.

______________________________Name of Officer/Agent _____________________________Signature

As an authorized agent for the Citizen Patrol organization making this application to join the NACOP, I/we understand the above statement and believe the information provided on this form to be true and correct.

Upon receipt of your application, along with a check or purchase order, we will mail your  window decals with a Proof of Mailing method. Please allow 2-4 weeks for receipt of your initial membership package containing the above  MA0708