

Application
for
Reciprocal Membership
Membership is requested into: _________________________________________________________________
(Please indicate which organization you are applying to.)
Date of Application: _____________________
Name: __________________________________ Patrol Affiliation: _________________________________
Address: ______________________________________________ Social Security Number: _____________________
City:________________________________________State: _________________Zip:______________
Telephone: ____________________________NSP or PSPA Certified Number:_____________________
Date you completed the components of the discipline you are applying from: ____________________
The opportunity to apply to either organization through the reciprocal agreement between the NSP and the PSPA is a result of good working relationship between us. Both organizations rely on their members to support the philosophies and standards that have made these two programs a sought after accomplishment. Examiners and officers of both organizations are members who believe in and are willing to commit their time and energies into strengthening their programs. A requirement of this application is a letter of introduction outlining what your commitment to the organization you are applying to will be, and how you plan on becoming involved to help us to preserve and strengthen the program.
To be eligible applicants must meet the following requirements:
NSP: Karl Johnson, 297 Granite St., Quincy, MA
02169-4931, 617-472-3193 johnson.building@comcast.net
PSPA: Dave Hill, 50 Brentwood Rd., Exeter NH 03833 daveh@loonpatrol.org