Name of Applicant (in full) ____________________________________________________ Spouse _____________________

Birth Date ___________________ Birth Place __________________________________ Citizenship ____________________

Home Address __________________________________________________ Home Phone ____________________________

Name of Employer ____________________________________________ Your Title ________________________________

Address of Employer ___________________________________________ City/State/Zip _____________________________

Work Phone ________________________ Fax Number ________________________ Number Years as Landman __________

Please Send All Mail To: Home Address ______ Work Address ______

Job Description ______________________________________________________________________________________
(Brief statement may be attached)

Are you a member of the American Association of Professional Landmen? _______________

I, the undersigned, acknowledge I have read the standards of membership and state that I am qualified for membership I the classification for which application is herewith made. (Place Ö beside appropriate status).

________ ACTIVE MEMBERSHIP in the Appalachian Association of Professional Landmen shall be limited to professional landmen regularly engaged in land work for a period of two (2) years. Where salaried, his employer must be regularly engaged in the land business. Once qualified under this section, eligibility under this sub-section shall not be affected by location, classification of employment, departmental or managerial assignment.

________ ASSOCIATE MEMBERSHIP shall be limited to persons who are associated with land work or have less than two (2) year experience. Associate members shall have all the rights and privileges of Active Members except those of voting and holding office.

Date ____________  Signature of Applicant _______________________________________________________________

We, the undersigned, as Active Members of the Appalachian Association of Professional Landmen are acquainted with the above applicant and recommend membership be accepted.*

I, ____________________________________________ approve as ______ Active Member ________ Associate Member

I, ____________________________________________ approve as ______ Active Member ________ Associate Member

I, ____________________________________________ approve as ______ Active Member ________ Associate Member

I, the undersigned, as Appalachian Association of Professional Landmen Director of President, state that this application should be _____ Approved _____ Rejected. (If rejected, please attach letter giving reasons).

Date ______________  Signature of Director or President ______________________________________________________

Approval of Membership Committee ______________________________________________________________________

Approval of Ethics Committee ___________________________________________________________________________

Appalachian Association of Professional Landmen membership is available to persons in land/land related activities who maintain acceptable professional and moral standards. Applicants must be recommended by three (3) Active members in good standing and have the application approved by an Association Director of the Association President.

Application Credit To: _________________________________________________________________________________

*If you are unable to secure three Sponsor signatures, please contact a member of the Appalachian APL.