Please Print this Page on legal size paper, complete form and mail to LAPL at P. O. Box 53491, Lafayette, LA   70505. Please Include your check for $50.00 (Active and Associate) or $15.00 (Student). PLEASE INCLUDE PHOTO FOR DIRECTORY (Optional)

Name:	Office Phone:
Company:	Home Phone:
Address:	Fax:
	Email:
Spouse:	Experience:

EDUCATIONAL BACKGROUND
	Name & Location	From	To	Graduated & Remarks
High School
College or University
Others (Military, Vocational)

PAST JOB EXPERIENCE
Employer	Job Title	City & State	Date of Employment
1.
2.

Give a brief but specific statement setting forth the experience which qualifies you for ACTIVE, ASSOCIATE or STUDENT membership.  Applicants should describe in detail by year and month land work relating to the mineral or energy industries (use separate sheet if necessary) or supervision of persons engaged in land work.

Applicant is asked to secure sponsoring signatures of TWO (2) ACTIVE MEMBERS, so selected that can verify applicant's experience. Sponsors are not to sign application unless they know applicant personally and can attest. Sponsors are to sign sponsor letters with this application if applicant is not currently a member of the AAPL or of any other Landman's Association. Sponsors may be required to answer additional questions bearing upon applicants qualifications, and should not sign as sponsor unless willing to supply such information.

SIGNATURES OF SPONSORS ARE REQUIRED ON THIS APPLICATION

1.____________________________________________________________________Title:___________________________________
Print Name:______________________________________________________

Company:__________________________________________Address:__________________________________________________
2._____________________________________________________________________Title:__________________________________
Print Name:______________________________________________________

Company:_______________________________Address:_____________________________________________________________
I hereby apply for membership in the Lafayette Association of Professional Landmen. Upon my acceptance I agree to be bound by and to comply with the Code of Ethics of the Lafayette Association of Professional Landmen as contained within its by-laws. I understand that this application will be processed as quickly as possible by the Membership Committee, and that applicants name shall be listed as a prospective member on at least (1) monthly newsletter requesting comments from the general membership. My reciept of the LAPL newsletter shall constitute notification of my acceptance by the membership committee as a member of LAPL.

_______________________________________ Signature of Applicant

_______________________________________________ Approved by Membership Chairman

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