APPLICATION TO WRITE THE TECHNICAL PRACTICE EXAMINATION

APPLICATION TO WRITE TECHNICAL EXAMINATIONS
Please Print Clearly:

Name in Full

APEGGA Office Use Only

Mailing Address

Pseudonym Number

Member Number

Business Telephone:

Home Telephone:

Receipt Number

I hereby make application to write examinations in:

		May (year)______(Deadline date March 1)
		November (year) ______(Deadline date September 1)

Amount

I wish to write in:

		Calgary		Edmonton
		Medicine Hat		Lethbridge
		Fort McMurray		Red Deer
		Whitehorse or Yellowhead
		____________________________other, subject to approval

Type of Assessment

I wish to write the following examination(s):

Exam Number eg. 94-Prelim-1		Exam Name Calculus

Mark:

Enclosed is my cheque for $_________ ($100.00 each) made payable to APEGGA or
Visa Master Card AMEX #
Expiry Date:

Date:

____________________________

Signature:

_________________________________________________________

Note:

Applications will not be accepted after the deadline date. Candidates who cancel after the deadline or fail to write or pass the exams may not have their examination fees refunded, nor will a credit be carried to the next exam session.

Revised December 2000

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