Leadership Member Application  Effective as of 12 Sept 2012

Leadership member Fee $25.00 per year. . No member fee for general members. For those new members or current members interested in being a leadership member to obtain rank within the USCDA. Send check or money order in the amount of $25.00 made out to USCDA, along with this completed application to HQ’s 301 Forest Ave, Laguna Beach, CA 92651. For general members just complete this application and send it in.

 NAME: ____________________________________________________________________________________

ADDRESS: _________________________________________________________________________________

CITY:_____________________________________________________________________________________

HOME PHONE:_________________________________

WORK PHONE:_____________________________

CELL PHONE: ___________________

E-MAIL: ______________________

CURRENT OCCUPATION: ____________________________________

(LIST ANY) SPECIAL SKILLS: _________________________________________________________________

MARRIED: YES___ NO____

PHYSICAL CONDITION: EXCELLENT ____ GOOD ____ POOR ___ MILITARY SERVICE YES ____ NO _____

BRANCH _____________ MOS _______ RANK __________

What disciplines if any  have you completed training in? 

YOU MAY ATTACH A RESUME/BIO AND ANY CERTIFICATES OF

TRAINING TO THIS APPLICATION. 

All information you provide will be kept strictly confidential and used only for membership purposes. We will never share your personal information with anyone without your permission. Your records are not maintained at HQ. Therefore please keep a copy of all communication from USCDA HQ’s for your records. It is also your responsibility to keep records of your training and volunteer work as a ranking leadership member of USCDA. From time to time HQ’s may request a copy for promotions and other considerations.