Please Type Information:		Date: ___________________
____________________________	____________________________	________________________
Name of Applicant	Name of Spouse	Home Phone
____________________________	____________________________	________________________
Home Address	Town	State and Zip
____________________________	____________________________	Office Phone: _____________
Company	Title	Fax Number: _____________
____________________________	____________________________	________________________
Office Address	Town	State and Zip

Are you a member of the AAPL? _____ Yes; _____ No
Are you a CPL? _____ Yes; _____ No;
If yes, state number and expiration date # ______________; Expir. Date ___________
Do you have a Degree in Petroleum Land Management? _____ Yes, School: ___________; _____ No
How long have you been actively engaged in land work? _____________________________
State type of land work performed: (Active application only) ____________________________________
__________________________________________________________________________________
__________________________________________________________________________________

Would you be willing to work as a committee member or in some capacity for OCAPL? [ ] Yes; [ ] No

NOTE: PLEASE FILL OUT APPLICATION IN FULL ALONG WITH TWO ACTIVE OCAPL MEMBER SIGNATURES. APPLICANT MUST ATTACH A WALLET SIZE PHOTOGRAPH AND A CHECK FOR ANNUAL DUES OF $100.00. IF APPLYING AFTER JUNE, PLEASE CONTACT THE OCAPL OFFICE FOR THE PRORATION OF DUES.

_________________________________
Signature of Applicant

INFORMATION TO BE COMPLETED BY SPONSORS:

CERTIFICATION: the Certification of applicant by each of the members named below is verification by each member named below, that the applicant's ability, qualifications, character and professional conduct as a Landman is in accordance with the bylaws of the OCAPL. Further, recommended applicant has one or more years experience as a Landman or holds a Petroleum Land Management/Mineral Land Management Degree from a recognized college or university and is actively engaged in land work.

Date: _____________	Approved: _________	Rejected: _________
________________________________		_______________________________
Member of Committee		Member of Committee
________________________________		_______________________________
Member of Committee		Member of Committee