SOUTH CAROLINA
CAMPUS LAW ENFORCEMENT ASSOCIATION
(Federal ID # 57-0765329)

APPLICATION FOR MEMBERSHIP

(Type or Print)


Name: _____________________________________________ Title: _______________________

Employing Agency: ___________________________________________________________________

Agency Address (Street): ________________________________________________________________

Post Office Box (If Applicable): __________________________________________________________

City: ________________________________________ State: ________ Zip Code: ______________

Agency Telephone Number: (_____)___________________ Fax: (_____)_______________________

Email Address: ________________________________________________________________________

Home Address: ________________________________________________________________________

City: ________________________________________ State: ________ Zip Code: ______________

Home Telephone Number: (_____)____________________ Pager: (_____)______________________

Name of Spouse/Significant Other: _______________________________________________________

Application Date: ______________________________________ New  Renewal 

Membership Dues Enclosed:
 Institutional ($75Annually) July 1st - June 30th
Chief Administrator or Agency Executive and/or Command Staff

 Associate ($40 Annually) July 1st - June 30th
Other Agency Employee


Address Correspondence To: Chief Howard M. Cook
1301 Columbia College Drive
Columbia SC, 29203

**COPY AND DISTRIBUTE FORM AS NEEDED**

Promoting Safety and Security for South Carolina’s Higher Education Community