HOT SPRINGS VILLAGE CITIZENS POLICE ACADEMY
ALUMNI ASSOCIATION


MEMBERSHIP APPLICATION


Please write legibly:

Name _________________________________________________________________________________


Address _______________________________________________________________________________


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Phone (home) ___________________________________________________________________________


Phone (cell) _____________________________________________________________________________


Email address ___________________________________________________________________________


Membership level Individual (annual) $25 _______________    Lifetime $250 _______________   
  Couple (annual) $40 _______________    Lifetime $400 _______________   
NOTE: For a coupleís membership, both people must have completed the Academy.

Shirt size(s) ____________________   ____________________
Note: shirts are menís sizes

Make checks payable to HSVCPAAA and return to:
Hot Springs Village Police Department
attn: HSVCPAAA
113 Calella Road
Hot Springs Village, AR 71909

Interested in joining a committee or volunteering at special events? List special skills/interests:

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