RESPONSIBLE MEMBER DECLARATION
ASSUMING RESPONSIBILITY FOR EXISTING PERMIT HOLDER

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Permit Holder: 

(Company Name)
     
 

(Permit Number)
 

     

I, the undersigned, am a professional member or licensee of APEGGA and as a full time employee or member* of the firm undertake to provide responsible direction and personal supervision to that portion of the Permit Holder's professional practice performed by the organizational unit described below.

I have read the relevant sections of The Engineering, Geological and Geophysical Professions Act and the Regulations reproduced on the reverse side hereof and I agree to conduct the professional practice for which I have assumed responsibility in strict accordance with the requirements of relevant legislation and regulations.

I further specifically undertake to notify the Registrar of APEGGA in writing if I cease to accept the responsibility indicated below and advise reasons for relinquishing that responsibility.

 

NAME AND PROFESSIONAL
DESIGNATION
(P.Eng. P.Geol. P.Geoph.)
APEGGA
MEMBER #
BRANCH
OFFICE
LOCATION
ORGANIZATIONAL GROUP
(Discipline of Eng. Geol. Geoph.)
 
 
 
 
 

Signature

 
 
 
 
 

Signature

 
 
 
 
 

Signature

* Reference in the Act to a full time employee or member of the firm is interpreted to mean that the relationship between the APEGGA member and the firm is an ongoing and continuous one as distinguished from one that does not have the depth of responsibility normally associated with a full time employee relationship.

Revised December 2000