Kentucky Tactical Officers Association

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Member Registration Form

ACTIVE ($30.00) - Any Sworn person employed by a Governmental Agency, including military, who is currently assigned to a tactical unit within the State of Kentucky. (Tactical Operator, TEMS, CNU, HDU,etc.)

ASSOCIATE ($20.00) – Any retired sworn tactical officer, current tactical operator outside the state of Kentucky, or support personnel who is indirectly involved with a tactical unit.

TEAM ($225.00) – Team membership only includes active tactical operators (excluded is TEMS, CNU, HDU, etc.) . A separate application should be provided for each individual team member and/or additions to team membership.

Name *
Rank
Membership Type *	Active $30 Associate $20 Team $225
Mailing Address *
Phone *
E-Mail Address *
Agency *
Agency Address *
Agency Phone Number *
Assignment
Team Name *
Team Commander's Name *
KTOA Region *	Northern Central Southeastern Western
Expertise, Qualifications and Certifications
Certified KLEC Instructor?	YES NO
Are you willing to instruct for the KTOA?	YES NO
How will you be paying? *	Credit Card (on-line) Check (by mail) Purchase Order (by mail)
Comments

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September 07, 2010, 06:32:33 PM