Application for Permit to Practice as a Partner, Corporation or Other Entity

APPLICATION FOR PERMIT TO PRACTICE AS A PARTNER, CORPORATION OR OTHER ENTITY

Name of Organization

Mailing Address

Postal Code

Telephone Number

E-Mail

Fax

The above named organization hereby applies to APEGGA for a Permit to Practice.

Selection of fields of practice listed under the professions of engineering, geology and geophysics is not intended to be restrictive but is requested for statistical purposes only. However, members are reminded they are required by the Code of Ethics to practice only in their areas of competence as determined by their qualifications and experience.

Engineering
Aerospace	Chemical	Geological	Electrical & Electronics
Biosystems	Civil	Mechanical	Manufacturing/Industrial
Computer/Software	Environmental	Mining	Metallurgical & Materials
		Petroleum	Other Engineering Specialties
Geology

General	Geochemistry	Hydrology	Engineering
Economic	Palaeontology	Soil Science

Geophysics

General	Environmental	Remote Sensing
Petroleum	Mining
Other Occupations, Please Specify

Industry of Professional Practice		Consulting Non-Consulting

Description of Company's or Organization's principal activities:

Branch Offices are located at:

Declaration by Chief Operating Officer or his Authorized Designate

I ______________________________Member No. (if applicable) ______________ occupy the position of _____________________________in the applicant's organization and in that position have authority and undertake to maintain an organization in which the practice of the professions indicated above can be conducted in accordance with requirements described in The Engineering, Geological and Geophysical Professions Act with specific reference to Parts 1 & 4 of the Act and Part 7 of the Regulations.

I further undertake:

(a) To notify the Registrar in writing forthwith if the professional members or licensees of APEGGA who have assumed responsibility for the professional practice cease to be full time employees or shareholders of the applicant.

(b) To surrender permit stamps and certificates to the Registrar in circumstances where there are not members or licensees of APEGGA assuming responsibility for the professional practice of the applicant.

(i) Chief Operating Officer or his designate taking corporate responsibility for the applicant.

(ii) APEGGA members or licensees assuming responsibility for direction of the professional practice of the applicant.


(Signature)	(Date)

Enclosed is my cheque for $ 335.00 (G.S.T. included) made payable to APEGGA or Visa MasterCard #_________________ Expiry Date:_____________________________

For Office Use Only Permit No.________ Fee: $____________ Approved_____________________________
	(Registrar)
#________________

Declaration by Members or Licensees Assuming Responsibility for the Professional Practice

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 applicant'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	MEMBER #	OFFICE	ORGANIZATIONAL GROUP (Discipline or Operation)



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*Reference in the Act on 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 or responsibility normally associated with a full time employee relationship.

Revised December 2002