APPLICATION TO USE ENGINEERING, GEOLOGY OR GEOPHYSICS IN
COMPANY NAME

1500 Scotia One, 10060 Jasper Avenue
Edmonton, Alberta  T5J 4A2
Tel: (780) 426-3990, Fax: (780) 426-1877
1-800-661-7020

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.