COPPS Membership Registration

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Please complete all of the following information.

First name *

Last name *

Street Address *

City *

State *

ZIP Code *

Phone Number *

Email Address *

Citizen's Academy Class Attended *

Example: Spring 2017, Fall 2019

Background Check Certification *

All COPPS members are subject to an annual background check. Anyone with the following convictions on their criminal record will not be allowed to become or remain a member of COPPS: Any felony conviction, any sexual assault committed against an adult or child at any time, any domestic violence conviction.

By registering, you certify that you have reviewed the list of convictions and have not been convicted of any of the listed offenses.

Required

Background Check Information

To facilitate the annual background check, please provide the following information.

Date of Birth *

YYYY

Driver License Number *

Driver License State of Issue *

Driver License Date of Issue *

YYYY

Gender *

Female

Male

Annual Membership Dues

Membership dues can be paid by check (payable to COPPS - PO Box #2482 Parker, CO 80134), PayPal (COPPSinfo@gmail.com), or cash at a monthly meeting.

$30: Individual

$45: Couple

$60: Family

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