Our organization will sponsor the
2003 APEGGA Annual General Conference at the level indicated:

Patron ($8,000) Benefactor ($6,000) Supporter ($4,000) Contributor ($2,000)

Enclosed is a cheque for $ to cover our organization's sponsorship commitment, or

Invoice our organization for our sponsorship commitment, or

Charge the credit card account listed below for our organization's sponsorship commitment.

Credit Card Number:

Card Type: VISA MasterCard American Express

Expiry Date:


Signature:_____________________________________________________________

Organization's name as it should appear in the program and on signage:



Contact Individual:

Mr. Ms. Dr.

Professional Designation: P.Eng P.Geol. P.Geoph. Other

First Name:
Last Name:
Job Title:
Address:
 
Telephone:
Fax:
Email:
APEGGA Permit Number:
   

Please return completed form via fax (780) 425-1722 to:
Barb Robinson, CMP

The Association of Professional Engineers, Geologists and Geophysicists of Alberta 1500 Scotia One, 10060 Jasper Avenue Edmonton, AB T5J 4A2 Phone (780) 426-3990 Fax (780) 425-1722 email@apegga.org