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Please print out and fax to Nic Guindon at (780) 426-1877.

Membership #

Application for Registration University Student Membership

There are no fees to apply or to retain membership. ASAP is free for undergraduate 2nd, 3rd, or 4th year engineering or geoscience students registered at Alberta universities. Students are responsible for notifying APEGGA of any changes in personal information.

NOTE: Please ensure that you provide APEGGA with any changes in your personal information.

Name and Contact Information

Courtesy: Mr. Mrs. Ms.

Surname:
Given Name in Full:
Common Name and/or Initials:
Mailing Address:

City:
Province:
Postal Code:
Telephone:
Fax:
E-mail:
University Student ID #
Date of Birth:

Academic Information:

I am currently enrolled at the University of Alberta Calgary

Engineering

Chemical	Geomatics	Mining
Civil	Manufacturing	Oil & Gas
Computer	Materials	Petroleum
Electrical	Mechanical	Software
Engineering Physics

Geology

Geophysics

Date:

Signature:_________________________________________

Head Office 1500 Scotia One 10060 Jasper Avenue NW Edmonton AB T5J 4A2	Calgary Office 2200, Scotia Centre 700 2nd Street SW Calgary, AB T2P 2W1 403.262.7714 Fax: 403.269.2787

GST Registration #R106728603