1500 Scotia One 10060 Jasper Avenue NW Edmonton AB T5J 4A2 PH 780-426-3990 TOLL FREE 1-800-661-7020 FAX 780-426-1877

APPLICATION TO WRITE THE NATIONAL PROFESSIONAL PRACTICE EXAMINATION

Please Print Clearly: Name: (Last)
(First)

Member #

ATTENTION: Applications will NOT be accepted after the Deadline Date. Candidates who request a deferral to the next exam session after the Deadline Date, cancel after the Deadline Date, fail to write the exam, or do not pass the exam will not have their fees refunded nor will a credit be carried to the next exam session. Eligibility to write:

Note: DO NOT SUBMIT APPLICATION WITHOUT A MEMBERSHIP NUMBER

Mailing Address Please check one

Business

Residential

E-mail address Business # Home #

I wish to write the Professional Practice Examination in: Calgary Edmonton Cold Lake Fort McMurray Other Grande Prairie Lethbridge Medicine Hat Red Deer subject to approval.

- You are an active Memberin-Training with at least two years of engineering experience OR - You have applied to become a member of APEGA (i.e. submitted your application for membership registration and paid the registration fee) DO NOT submit your application without a member number.
Please contact: Jacqueline Huculak at jhuculak@apega.ca or 1-800-661-7020, Ext 2291 if you have any questions. APEGA USE ONLY NPPE Pseudonym #

Please submit application with payment to Jacqueline Huculak by fax to 780-426-1877, mail, OR scan and email to jhuculak@apega.ca prior to the Deadline Date. If you do not receive confirmation of receipt within 2-3 business days, please call APEGA.

2013/2014 Dates October 21, 2013 January 20, 2014 April 22, 2014 July 21, 2014 (Deadline Date September 3, 2013) (Deadline Date December 2, 2013) (Deadline Date March 3, 2014) (Deadline Date June 3, 2014)

Enclosed is my cheque for $147.00 made payable to APEGA or Visa # Expiry Date: An additional $105.00 writing fee is required for sites outside of Alberta (within Canada). An additional $262.50 writing fee is required for sites in the U.S. (Payable in Canadian Funds) An additional $420.00 writing fee is required for sites outside of North America. (Payable in Canadian Funds) Master Card AMEX

Member #

Amount

Order ID

Date

All fees are G.S.T. included. APEGA G.S.T. Registration #: 106728603

Name (please print): Signature: Date:
Revised JULY 2013

Mark