Miami-Dade County Association of Chiefs of Police

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Membership Application/Update Information

New Application Update Information
NOTE: Please only enter your name and the changed information if you are updating your file.

Active
Dues:                $150
Initiation:            $25
Total:                $175

Associate
Dues:                 $150
Initiation:             $25
Total:                 $175
Assoc Sponsor:
Fee Waived

Honorary
Gratis

Life-Active
Dues: $150

Life-Inactive
Dues $50

Name:

Rank/Title:

Date:

Agency/Organization:

Business Address:

Business Telephone:

Facsimile:

Home Address:

Home Telephone:

Email:

List Departmental Responsibilities:

Recommended By:
	(Agency Head or Sponsor)

Correspondence mailed to:
Office Home

Please print form and mail to:

(Ret) Chief Ron Gotlin
1120 NE 165 Terrace
North Miami Beach, FL 33162

Please make check payable to Miami-Dade County Association of Chiefs of Police and mail to the address above.

For further information, please call (Ret) Chief Gotlin at (305) 219-2396
or email to: chiefgotlin@aol.com