NAME:  TITLE:  

REPRESENTING:

MAILING ADDRESS:

                                                                

CITY: STATE: ZIP CODE:                                   

PHONE:     FAX:

E-MAIL ADDRESS:

 

CHECK ONE	MEMBERSHIP CLASSIFICATION	ANNUAL DUES
	Class A Member - A designated representative of a Governmental Agency engaged in the administration of codes, laws, and ordinances relating to building construction.	$25.00       (1 per jurisdiction)
	Class B Member - Any member from a Class A Governmental Agency engaged in the administration of codes, laws, and ordinances relating to building construction.	$25.00       for 2nd $20.00       for 3rd $15.00       for 4th $10.00       for 5th $  5.00       for 6th or more
	Professional/Associate Member - An individual or firm interested in the objectives of the Association.	$40.00
	Student Member - A student enrolled in construction, engineering, architecture, or related field of study and interested in the objectives of the Association.	$10.00
	Retired Member– Any former member who is retired.	$10.00
	Honorary Member—A member given honorary status.	No Charge

 

Signature:_________________________________________________ Date:___________________

 

Amount Enclosed:_________________

  

Submit completed application with payment in the form of a check to the following address:

 

CAPT

P O Box 18066

Golden CO 80402                                                                                              

Colorado Association of Permit Technicians

2012 Membership Application Form

 

Complete a separate application form for each individual