Download Application - Retirement Gift - New - Canadian Military Intelligence

Canadian Military Intelligence
Association
Association Canadienne de
Renseignement Militaire
PO Box 38, 4338 Innes Road, Ottawa ON K4A 3W3
REQUISITION FOR RETIREMENT PLAQUE
(once complete, email to [email protected])
PART 1: DECLARATION
(You must check one box below. Plaque will not be prepared/shipped otherwise.)
I am the retiring member and I have read, understood, and will abide by the below
I am the DWD Coordinator for the retired member and I have explained the above to the retiring member
who understands and will abide by the below.
A Member is only entitled to one plaque, including one engraved plate and one-time shipping and handling
paid for, in full or in part, by the Association. This plaque is intended to mark a Members final departure from
the Branch. Members who receive this plaque upon retirement from the Regular Force and then serve in the
Reserve Force will not entitled to a second engraved plate to mark their subsequent retirement from the
Reserve Force. Personnel who intend to serve in the Intelligence Branch as a Reservist following their
Regular Forces career should apply for their plaque upon their retirement from the Reserve Forces.
The Association will bear the cost of the plaque, engraving and shipping pro-rated at 10% for each year of
Association membership. The member is responsible for paying residual costs over and above the amount
paid by the Association. Upon completion of 10 years of membership, the Association will bear the full cost
of the plaque, engraving and shipping. Personnel who have never been Association Members must pay full
cost but must apply to the Association’s Executive Committee for the plaque.
PART 2 : DETAILS OF THE RETIRING MEMBER
(Completed by the retiring member or DWD Coordinator note that at least 30 days notice is usually required
to allow for engraving and shipping)
Last Name:
First name and Initials:
Rank:
Current Component
(Check One):
Unit:
Service number:
Regular
Reserve
Date of release:
Enrolment date (in CAF):
Date joined Intelligence Branch or Predecessors:
I am a current member of the Association:
Yes
If you are a past member, what years where you a paying
member (approx)?
I qualify as a “Founding Member”:
No
From
Yes
No
To
PART 3: ENGRAVING
Please ensure that the following boxes are properly completed. The Association will take responsibility for,
and will pay to replace, any engraved plate when the error results from the actions of the Association. Where
the error results from inaccurate information provided below, the Member or responsible DWD Coordinator
shall bear the cost of the replacement engraved plate.
Inscriptions shall be in styles as indicated. Dates of Service shall indicate all CAF service, not just service in
the Branch.
Style
Name:
PO2 M.A. Jones, MMM CD
Dates of Svc:
1 Oct 1975 – 31 Mar 2007
Motto:
E Tenebris Lux
PART 3: SHIPPING
Date Required:
Name:
Unit (if required):
Address:
City:
Province/State:
Country:
Postal/Zip Code:
1 January 2002