ONTARIO POLICE

HEALTH & SAFETY ASSOCIATION

Darwin Trojan, Chair
C/O York Regional Police Service
17250 Yonge Street, Newmarket Ontario L3Y 4W5
5262@yrp.ca Telephone # (905)895-1221 Ext. 7908

2010 Membership Application

Police Service: ______________________________________________________

Address: ______________________________________________________

______________________________________________________

______________________________________________________

Chief of Police: ________________________ e-mail ________________________

Management Rep: _________________________e-mail ________________________

Association Rep: _________________________e-mail ________________________

Enclosed is a Cheque or Money Order in the amount of $100.00, which

provides the Police Service both Management and Association representation for the
2010 calendar year. Cheques should be made payable to:

“Ontario Police Health and Safety Association”

The minutes of all meetings will be forwarded to the Chief of Police, Management and
Association Representative for dissemination to the Joint Health and Safety Committee.

Please forward this application along with the membership fee to:

Lori Taylor
Treasurer – Ontario Police Health and Safety Association
C/O Halton Regional Police Service
1151 Bronte Road, P.O. Box 2700, Oakville, Ontario, Canada L6J 5C7
PHONE: (905) 825-4859 FAX : (905) 825-3732