Fillable MEMBERSHIP APPLICATION

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MEMBERSHIP APPLICATION

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The MEMBERSHIP APPLICATION form is 4 pages long and contains:

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  • 17 check-boxes
  • 108 other fields

Country of origin: CANADA
File type: PDF

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Municipal Law Enforcement Officers’ Association (Ontario)
MEMBERSHIP APPLICATION
NEW ☐ RENEWAL ☐
Applicant Name:
Last Name
First Name
Initial
Applicant Title:
Municipality:
Supervisor Name: Phone:
Municipal Address:
City: Postal Code:
Home Address:
Work Email:
Phone:
Super
visor may be contacted to verify the above person(s) is employed as a Municipal Law Enforcement Officer and is
authorized by his/her terms of employment to enforce by-laws, lay charges and appear before the courts in the capacity of
a Municipal Law Enforcement Officer.
Type
(check one)
Classification
Fee
# Votes
Required documentation:
☐
Regular $110.00 1
Please provide copy of appointment by-
law or certification noted below
☐
Associate $83.00 No vote
Please provide copy of appointment by-
law or certification noted below
☐
Associate
(student)
$83.00 No vote
Please provide proof of educational
institution & program or
diploma/degree/certificate
☐
Corporate
(Municipal)
See
Schedule
A
See chart
Municipal Population: _____________
(Please include list of all individuals to be
included on membership)
☐
Corporate
(Service Group)
See
Schedule
B
See chart
Group Size (# of individuals):________
(Please include list of all individuals to be
included on membership)
☐
Retired $17.00 1 vote
☐
Life No Charge 1 vote
☐
Honorary No Charge No vote
METHOD OF PAYMENT
Payment
Type
(check
one)
☐
Amount:
Please make cheques payable to:
Municipal Law Enforcement Officers’ Association
☐
CREDIT CARD
Amount:
$
☐
MASTERCARD ☐ VISA
CREDIT CARD #:
EXPIRY DATE:
NAME ON CARD:
EMAIL RECEIPT TO:
☐
I authorize the MLEOA to debit my account for the above funds.
Return completed forms to:
Questions?
Kim Fairfull
Membership Administrative Support
MLEOA
16 Malvern Crescent
Guelph, ON N1L 1G8
kim.fairfull@mleoa.ca
Doug Godfrey, MLEO(C)
Membership Chair
MLEOA
doug.godfrey@mleoa.ca
CORPORATE MEMBERSHIP RATES
Municipal only
Corporate Membership (Municipal): in the Association shall be available to a
municipality for persons who would qualify as Regular members of the
Association depending upon the population of the municipality as set out in the
Provincial Municipal Directory for the current year. (See “Law Enforcement
Service Group” for organizations other than municipalities who provide municipal
law enforcement services)
Municipal Population
Annual Fee
Representation
(# of votes)
1 to 9,999
$ 168
2
10,000 to 24,999
$ 241
2
25,000 to 49,999
$ 309
3
50,000 to 99,999
$ 399
3
100,000 to 199,999
$ 483
4
200,000 to 499,999
$ 799
5
500,000 to 549,999
$ 859
6
550,000 to 599,999
$ 920
7
600,000 to 649,999
$ 980
8
650,000 to 699,999
$ 1,041
9
700,000 to 749,999
$ 1,101
10
750,000 to 799,999
$ 1,162
11
800,000 to 849,999
$ 1,222
12
850,000 to 899,999
$ 1,283
13
900,000 to 949,999
$ 1,343
14
950,000 to 999,999
$ 1,404
15
Over 1,000,000
$ 2,069
16
CORPORATE MEMBERSHIP RATES
Law Enforcement Service Group only
Law Enforcement Service Group Membership: in the Association shall be
available to a Service Group for persons who would qualify as Regular members
of the Association depending on the number of persons in the group. (See
“Municipal” for municipalities.)
Group Size
Annual Fee
Representation
(# of votes)
2 - 50 officers
$ 168
1
51 - 100 officers
$ 241
2
101 - 150 officers
$ 483
3
151 - 250 officers
$ 799
4
Over 250 officers
$ 859
5
CORPORATE/GROUP MEMBERSHIP LIST
Name of applicant
(first, last, initial)
Title Business Address Business Email
Business
Phone and
Extension
Receive
Seal (Y/N)
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MEMBERSHIP APPLICATION

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Completed 11 April 2021

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