Membership Application

Last Name

First Name

Home Street Address

State

Zip Code

Phone number

Date of Birth

Type of Membership

Regular Active $40

Associate $50

REGULAR MEMBERSHIP $40.00 ANNUALLY

Are you a certified Law Enforcement Officer

Yes

No

Do you have the power to arrest?

Yes

No

Does your law enforcement employer use you and the K9?

Yes

No

Employer

Work Street Address

City

State

Zip Code

Work Phone

Position

Handler

Trainer

Retired LE

Other

If other please describe

ASSOCIATE MEMBERSHIP $50.00 ANNUALLY

Please indicate that which applies

Regular member sponsoring you

Sponsor phone number

If you do not have a sponsor, how did you hear about OLEKA?

K9 INFORMATION

Name

Age (years, months)

Date of birth

Sex

Male

Female

Breed

Color(s)

NOTE: All personal checks that are returned will be charges a $30.00 fee in addition to the membership fee and any bank fees you incur.

All applications are subject to background check for authenticity and integrity. By submitting this application, you agree that all information is correct and truthful to the best of your knowledge.

I agree with your terms and conditions

DONATE TO OLEKA

“He is your friend, your partner, your defender, your dog. You are his life, his love, his leader. He will be yours, faithful and true, to the last beat of his heart. You owe it to him to be worthy of such devotion.” - Mike Ritland



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