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Available in PDF Format

APPLICATION TO WRITE THE
NATIONAL PROFESSIONAL PRACTICE EXAMINATION

Please Print Clearly:

Name in Full

APEGGA OFFICE USE ONLY
Mailing Address



Pseudonym Number

Member Number

Amount

Email Address:
Business Telephone:
Home Telephone:

Receipt Number
I wish to write the Professional Practice Examination in:
Calgary Lethbridge
Edmonton Medicine Hat
Fort McMurray Red Deer
Grande Prairie
________________________other, subject to approval. For additional instructions contact Jocelan Tanner, Examinations Coordinator at 1-800-661-7020 or email: jtanner@apegga.org prior to the Deadline Date.
Engineer
Geologist
Geophysicist
M.I.T.
Prof.Member Appl.
R.P.T. (Eng) Appl.











on:
April 14, 2003 (Deadline Date - February 28, 2003)
July 21, 2003 (Deadline Date - June 3, 2003)
October 20, 2003 (Deadline Date - September 1, 2003)
January 19, 2004 (Deadline Date - December 1, 2003)
  Mark
Enclosed is my cheque for $100.00 (G.S.T. exempt) made payable to APEGGA or

Visa   Master Card AMEX
Card #        Expiry Date:
Additional $50.00 "USA Writing Fee" is required (Payable in Canadian Funds).

Date:Signature:

____________________________ _____________________________________
Note: Applications will not be accepted after the Deadline Date. Candidates who request a deferral to the next exam session after the Deadline Date, cancel after the Deadline Date, fail to write the exam, or do not pass the exam will not have their fees refunded, nor will a credit be carried to the next exam session.

Revised: November 2002