APPLICATION FOR PERMIT TO PRACTICE
AS A PARTNERSHIP, CORPORATION
OR OTHER ENTITY
(Please complete and return with registration fee to the address indicated below)

(Registration fee of $205.00 must accompany application)

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:

Engineering -

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

Geology -

General Geochemistry Hydrology Engineering
Economic Paleontology 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, 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 Part 1 of the Act and Part 10 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.
(c) To report on an annual basis the names of

(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 $205.00 (G.S.T. exempt) 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)
_____________________

_____________________
Signature
_____________________

_____________________
Signature
_____________________

_____________________
Signature
_____________________

_____________________
Signature
_____________________

_____________________
Signature

* Revised wording is a proposal, subject to review and approval.

The Association of Professional Engineers, Geologists and Geophysicists of Alberta
15th Floor, Scotia Place, Tower One
10060 Jasper Avenue
Edmonton, Alberta T5J 4A2
Tel: (403) 426-3990; Fax: (403) 426-1877

 

 

 

 


APPLICATION TO USE ENGINEERING, GEOLOGY
OR GEOPHYSICS IN COMPANY NAME

Company Name:
Mailing Address:
 
 
Telephone No.:

 

I, , Chief Operating Officer or Authorized Designate of the above named company undertake to maintain a valid Permit to Practice with the Association of Professional Engineers, Geologists and Geophysicists of Alberta so long as any of the words Engineering, Geology or Geophysics, or variations thereof, are used in the company name.

I further undertake, in the event that the Permit to Practice is cancelled for any reason, to deregister the company with the Corporate Registry of the Province of Alberta or remove the words Engineering, Geology or Geophysics as applicable from the company name.

 

___________________________________________________ ________________________

Signature

Date

The Association of Professional Engineers, Geologists and Geophysicists of Alberta
15th Floor, Scotia Place, Tower One
10060 Jasper Avenue
Edmonton, Alberta T5J 4A2
Tel: (403) 426-3990; Fax: (403) 426-1877