Departure Memento Application Form (2024) - Formulaire de demande de note de départ (2024)

IMPORTANCE NOTICES:

Engraving is based on the information provided on this form. Any spelling mistakes or errors on the form will result in errors on the engraving. The costs for any re-engravings needed because of such errors must be paid for in advance.

The CMPA departure memento is normally provided free of charge to qualifying CMPA members if the departure memento application is received before, or within three months of, the member’s release date and the member has become a CMPA member in good standing within that time. Application may be made to the President of the CMPA to extend or waive this time limitation in extenuating circumstances.

If you are not entitled to a free departure memento, or have chosen additional options, the CMPA Kit Shop will send you an invoice that must be paid in full prior to your request being further processed.

Please see the CMPA Bylaws for explaination of entitlements and types of mementos at CMPA Bylaw 5

Date you became a MP*

DayMonthYear

Date retired or released as a MP*

DayMonthYear

MP Badge Number

(Last Issued Badge Number)

Last MP Unit and Base

CMPA Membership Number

Civilian Email*

example@example.com

Phone Number (That you can be reached at after release)*

Please enter a valid phone number.

Full Formal Name for engraving, include any post-nominals "CD, MMM etc."*

RankFirst NameMiddle Initial(s)Last NamePost Nominals

What Departure Memento are you applying for?*

Type One - MP Badge (Your issued MP Wallet Badge)Type Two - Never CredentialledType Three - Non MP

I want my engraving in*

EnglishFrench

If you are requesting a Type One Departure Memento, please select one of the following options. (click on the image for a diagram) Applicable taxes extra. Shipping and Handling included.

WU 44 Upright Wedge Clear with Red Accent Product Image

WU 44 Upright Wedge Clear with Red AccentThis is an upright mounting, clear with gold lettering and a red accent. Free for CMPA Member.

$225CAD

WU 44 Upright Wedge with Red Background Product Image

WU 44 Upright Wedge with Red BackgroundThis is an upright mounting with gold lettering and a red background. Free for CMPA Member.

$225CAD

W 44 Flat Wedge Clear with Red Accent Product Image

W 44 Flat Wedge Clear with Red AccentThis is a flat wedge mounting, clear with gold lettering and a red accent. Free for CMPA Member.

$225CAD

W 44 Flat Wedge with Red Background Product Image

W 44 Flat Wedge with Red BackgroundThis is a flat wedge mounting with gold lettering and a red background. Free for CMPA Member.

$225CAD

Badge Enamel Lettering Repair (Optional)Please select this option if you would like the black enamel lettering or numbers on your badge repaired. The cost for this service is not paid for by CMPA and you will receive an invoice prior to work starting. (NOTE: All badges receive a cleaning to remove oils and other contaminants that could impact upon the embedding of your badge.)

$10CAD

Total

$0.00CAD

I want my departure memento mailed

To meTo my DWD Coordinator

Address to send the Departure Memento (MUST be an address Canada Post will deliver to as a signature will be required for delivery)*

Street Address (or PO Box Number)

Apartment

CityProvince

Postal Code

Special Instruction / Comments and DWD Coordinator Name/Unit

DWD Coordinator Phone Number

Please enter a valid phone number.

DWD Coordinator Email

example@example.com

Please verify that you are human*