Application for MEMBERSHIP

Title

Name

Date

Qualifications: (provide copies of the certificates and relevant documentation)

The Elevating Devices Professional Association - Career Mapping Document

Designation:

Organization: AHJ. :

Address for correspondence:

Address 1:

Address 2:

City: Prov./State:

Country: Postal Code/Zip:

Phone Numbers:

Mobile: Home Phone:

Fax:

E.mail:

Other:

I am interested in membership in the Elevating Devices Professional Association.
I would like to be considered for the following class of membership.

1. Certified Elevating Device Professional - Member2. Certified Elevating Device Professional – Professor3. Certified Elevating Device Professional – Technician4. Certified Elevating Device Professional – Operator5. Certified Elevating Device Professional – Inspector6. Certified Elevating Device Professional – Supplier7. Certified Elevating Device Professional – Technologist I8. Certified Elevating Device Professional - Technologist II9. Certified Elevating Device Professional - Technologist III10. Certified Elevating Device Professional - Technologist III

Name and address of prospers with Membership Number: Membership Number Name Address

Signature 1:

Signature 2:

I have read the code of conduct and I am returning a signed and dated copy. Initial:

I have read the Code of Ethics and I am returning a signed and dated copy. Initial:

I have read the constitution and bye laws of the society and will abide by the same.

Date: Place:

Signature: