Membership Application - June 1, 2010 - May 31, 2011
Fill-out, print on legal paper, and mail this application and a check for $50.00 Dues to:
East Texas Association of Petroleum Landmen 
P. O. BOX 252 TYLER, TEXAS 75710 
I apply for: New Renewal membership in the East Texas Association of Petroleum Landmen.

First Name Middle Initial Last Name 
Birth Date    Spouse

Mailing Address 
City State Zip Code 

Home Address 
City State Zip Code 

Business Phone:  Home Phone:  Cell Phone:
Fax: Email: 

Check Appropriate Current Affiliation Box
AAPL CPL RPL  RL
Certification Number: 
Enter name of company or indicate "independent": 
Membership Classification:

ACTIVE: Professional Landmen regularly engaged in land work relating to the mineral or energy industry.

ASSOCIATE: Parties who are directly, primarily and regularly engaged in performing services in the energy field not falling into the ACTIVE classification. 

SENIOR: Professional Landmen at least 65 years of age and with at least 10 years active experience in Landwork.  A Senior Member may still be actively engaged in Landwork, or may be retired.
Briefly list your duties and/or position and your experience:  

Applicant must list one (1) CPL ACTIVE member or (3) ACTIVE members as reference.

Name  Phone: 
Name  Phone: 
Name  Phone: 


  Applicant's Signature _____________________________________
MEMBERSHIP COMMITTEE USE ONLY.
APPROVED DISAPPROVED - DATE
Chairman, Membership Committee (signature block)