Membership Application

Apply to become a member of the East Texas Association of Petroleum Landmen

Applicant Name

First Name *

Middle Name

Last Name *

Suffix

Contact

Email *

Date of Birth

Business Phone

Mobile Phone

Fax

Spouse (Optional)

First Name

Middle Initial

Last Name

Company

Company Name

Street Address

Suite/Unit

City

State

Zip Code

Job Duties Description

Primary Address

Street Address

Apt/Suite

City

State

Zip Code

Make this my default mail address

Secondary Address (Optional)

Street Address

Apt/Suite

City

State

Zip Code

Make this my default mail address

Affiliations & Credentials

Current Affiliations

AAPL Number

CPL (Certified Professional Landman)

RPL (Registered Professional Landman)

RL (Registered Landman)

ROW (Right of Way)

References

Please provide at least 2 references who are active ETAPL members. *

Reference 1 Name

Reference 1 Phone

Reference 2 Name

Reference 2 Phone

Reference 3 Name (Optional)

Reference 3 Phone (Optional)