Membership Form

Pursuant to the Federal Privacy Act (Public Law 93-579) and the Information Practices Act (IPA) of 1977 (Civil Code Sections 1798, et seq.), notice is hereby given for the request of personal information. Failure to provide all or any part of the requested information may delay processing of this form or result in an incomplete record. No disclosure of personal information will be made unless permissible under Article 6, Section 1798.24 of the IPA of 1977. Each individual for whom personal information is collected has the right to inspect that information in any record maintained by CCGIA. Inquiries may be directed to the CCGIA Board of Directors at the address listed on our “contact us” page.

INSTRUCTIONS
Please complete ALL sections of the application. Failure to complete any section of this application will result in a delay in processing the application.

Read this application in its entirety. By signing the application you are signifying that you read the entire application and agree to all terms therein.

Type or legibly print (in ink) all required information. The fastest way to be considered for membership is to fill this application out online, and return it via email to membership@ccgia.org.

** All membership applications will be reviewed by the CCGIA Board of Directors. CCGIA reserves the right to approve or reject any application, for any reason they deem necessary. Furthermore, CCGIA reserves the right to cancel any membership at any time, for any reason, with or without explanation to the involved parties**

Name (First and Last)

Current Occupation

Current Employer

Agency Address

Apt, suite, etc.

Country

City

State

Zip code

Phone Number

Type of Membership you are Signing Up For

Topics in which you instruct (if any)

Organization you instruct for

How long have you been instructing?

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By reading and completing this membership application for Central Coast Gang Investigator Association, I agree to the following terms and conditions.

Any and all information that I am given access to, be it written or verbal, that is deemed to be “Confidential Law Enforcement” material, I will not share, disseminate, or in any other manner give access to any person or entity that does not have authorization to view such information
I understand that the CCGIA and all of its staff / faculty are not responsible in any manner for any use on my behalf, of any information or training that I receive from their organization and release and indemnify them from any liability or legal action, be it criminal or civil.