Application WVPCA 15th Annual Seminar

April 19 – 23, 2010 Charleston, West Virginia
You do not have to be a police officer or WVPCA member to attend. Everyone is welcome.

 

Officer/Applicants Name                                                              Rank                         

 

Place of Employment                                                                                                       

 

Employment Address                                                                                                      

 

Phone Number                                 Years of Service               K-9 Name                

 

K-9 Age                     K-9 Years of Service                     Breed                                   

 

K-9 Fields of Training                                                                                                      

 

                                                                                                                                               

 

                                                                                                                                               

 

Organization Affiliations:                                                                                                 

 

                                                                                                                                              

 

                                                                                                                                               

 

Mark the topics you are most interested in:       Please mail fee and application to:

 

1) Patrol                                        ______                                  WVPCA

2) Narcotics detection              ______                            DOUG ADAMS                

3) Explosives detection            ______                             PO BOX 292

4) Tracking/evidence search   ______                      LESAGE, WV  25537

                                                                                                   304-963-1565
                                                                                    

Method of Payment, $125.00 fee:  Cash                Check                 P/O #                     

 

WAIVER OF LIABILITY

By signing below I agree to act in a safe manner and abide by all instructions

given by the trainers. I also Agree to keep my K-9 under control at all times during

the seminar. Further more, I agree, that the WVPCA will in no way be held liable,

responsible or accountable for any damages or injuries that myself or my K-9 may

cause or sustain.  I hereby Acknowledge by my signature below, that I have read

and understand the above waiver of rights.

 

Signature:                                                                              Date: