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NAME:_______________________________________TITLE:___________________________

REPRESENTING:_______________________________________________________________

MAILING ADDRESS:_____________________________________________________________________

                                                                 Street or P.O. Box

                                        ______________________________________________________________________________

                                                                                     City                                                            State                                           Zip Code

PHONE:( _______ )__________________  EXT: ________    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 and thereafter

                       

     [    ]

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       

 

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

2010 Membership Application Form

 

Complete a separate application form for each individual

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