Application for Membership
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I _______________________________________________________________hereby make application for membership
in the Association. Fiscal Year: May 1, 200______ to May 1, 200______
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Occupation:_________________________________________ Employer:__________________________________________·
Address:_____________________ City/Town: ___________________ Zip: _____ Position:__________________________·
Office Hours:_______________________________ Office Phone: _______________ Extension: ___________·
Office Fax: _______________ Ofc E-mail :_______________________ Ofc Web Adrs: _____________________________·
Home Address: ______________________ City/Town: __________________________ St: _____ Zip Code:________·
Home Phone: _______________ Home Fax: _______________ Home: E-mail: :___________________________________·
Home Web Address: ____________________________________ Spouse: _______________________·
Type of Membership applied for: ( ) Active Membership ( ) Sponsor ( ) Associate ( ) Retiree -Other·
Type of License Applicable: ( ) Plumber ( ) Gasfitter ( ) Master ( ) Journeyman ( ) Mechanical·
Emergency Contact: ____________________________________ Emergency Contact Phone: _______________________·
INSPECTORS ONLY ( ) Part Time ( ) Full Time·
Inspection Hours:_______________________________________ Population: _____________________________________·
Wages, minimum:____________________________ Maximum:___________________ Percentage: ____________________·
Car Allowance:_________________________________ Other Perks:__________________________________________
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Signature of Applicant:_________________________________________________Date:___________
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Signature of Sponsor:__________________________________________________Date:___________·
Print Sponsor’s Name: ____________________