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Oil and Gas Land Review and CPL and RPL Exam - American ...

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REGISTRATION FORM(Please type or print legibly)Name ______________________________AAPL member # _______<strong>Oil</strong> <strong>and</strong> <strong>Gas</strong> L<strong>and</strong><strong>Review</strong> <strong>and</strong> <strong>CPL</strong>/<strong>RPL</strong><strong>Exam</strong>s722<strong>CPL</strong>Denver, COJuly 22-25, 2013Company ________________________________________________Address _________________________________________________City, ST Zip Code__________________________________________Phone ______________________ Fax ________________________E-mail ___________________________________________________REMIT CHECK:AAPLP.O. Box 225395Dallas, TX 75222-5395REMIT CREDIT CARD :AAPL4100 Fossil Creek BlvdFort Worth, TX 76137Fax: (817) 546-6441AAPL Contact:Stephanie Rickels(817) 847-7700srickels@l<strong>and</strong>man.org<strong>CPL</strong>/<strong>RPL</strong> <strong>Review</strong>/<strong>Exam</strong>AAPL MemberNon AAPL MemberPLM/ERM StudentTuition Assistance(AAPL members only)(Request Attached)<strong>RPL</strong> <strong>Review</strong> <strong>and</strong> <strong>Exam</strong>Day 1 Only(AAPL members only)Registrations <strong>and</strong> Payment Received:Thru 7/8/2013 After 7/8/2013 $470 $570 $0 $0 $300MUST Indicate <strong>Exam</strong> Choice $520 $620 $50 $50 $350No exam<strong>RPL</strong> Tuesday<strong>CPL</strong> Thursday<strong>RPL</strong> ThursdayOFFICE USE ONLYRECEIVED:POSTED:Payment Information Check #________ MasterCard Visa <strong>American</strong> ExpressCredit Card # _____________________________________________Exp. Date _________Card Security Code (CSC): _______________Name on Card ____________________________________________Signature _________________________________________________

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