Membership Application/Renewal
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Membership Application New York State Association of Professional Land Surveyors, Inc. 146 Washington Avenue, Albany, NY 12210 (518) 432-4046 www.nysapls.org Full Name: Combined Regional & NYSAPLS Dues – check ONE Date of Birth: ____/____/____ NYS LS License #: Regional Regular Assoc. E-mail: Allegheny Plateau Association of Membership Year: _______-_______ Professional Land Surveyors $315.00 $85.00 (Allegany, Cattaraugus, Chautauqua, Western Steuben) NYSAPLS Membership Year runs from July 1st – June 30th Black River Valley Association of Professional $315.00 $85.00 Land Surveyors (Jefferson, Lewis) Catskill Area Association of Land Surveyors $310.00 $75.00 Work/School Profile: (Delaware, Otsego, Schoharie) Central New York Society of Land Surveyors Company/School Name: $335.00 $80.00 (Cayuga, Cortland, Madison, Onondaga, Oswego) Job Title: Delaware-Hudson Land Surveyors $360.00 $95.00 Website: Association, Inc (Orange, Rockland, Sullivan) Address: Eastern NY Society of Land Surveyors, Inc. (Albany, Columbia, Fulton, Greene, Montgomery, Saratoga, $315.00 $80.00 City, State, & Zip: Schenectady, Warren, Washington) Work Telephone: (_______) _______-_______ Genesee Valley Land Surveyors Association $340.00 $95.00 (Livingston, Monroe, Ontario, Wayne, Yates) Fax: (_______) _______-_________ Long Island Association of Land Surveyors $385.00 $105.00 Total # employees in firm: _________ (Nassau, Suffolk, Queens) Mid-Hudson Valley Land Surveyors Total # staff employed in surveying dept: $325.00 $85.00 Association, Inc. (Dutchess, Ulster) Supervise Staff? □ Yes □ No # _______ staff supervised Mohawk Valley Society of Professional Land $310.00 $77.50 Firm Specialty: [ ] Land Surveying Services Only Surveyors (Herkimer, Oneida) [ ] Engineering Services only Nassau-Suffolk Civil Engineers, Inc. $395.00 $100.00 [ ] Multi-disciplinary firm (Nassau, Suffolk, Queens) Niagara Frontier Land Surveyors Association Home Profile: $335.00 $95.00 (Erie, Genesee, Niagara, Orleans, Wyoming) Address: Northern NY Association of Land Surveyors $320.00 $85.00 City, State, & Zip: (Clinton, Essex, Franklin, Hamilton, St. Lawrence) Southern Finger Lakes Association of Home Telephone: (_______)_______-_________ Professional Land Surveyors $320.00 $90.00 (Chemung, Eastern Steuben, Schuyler, Tompkins) Which address do you prefer NYSAPLS to use as your mailing Southern Tier Association of Land Surveyors $310.00 $75.00 address? [ ] Work [ ] Home (Broome, Chenango, Tioga) Westchester-Putnam Association of □ Please check here if you do not wish to have your contact Professional Land Surveyors, Inc $485.00 $170.00 information displayed in a public format such as the NYSAPLS (Westchester, Putnam) website and printed membership directory. By not opting out, you At Large – Out of State are authorizing NYSAPLS to make your contact information available. $285.00 --- (Any regular member who resides outside of NY) You may opt out at any time. Alternate NYSAPLS Member Class Dues Education: □ Associates Degree [2yr] □ Bachelors Degree [4yr] □ Masters Degree □ High School Diploma Class Dues Corresponding Member $ 45.00 Payment Info Student Member $ 10.00 Suggested Donation: Scholarship Fund, $25 or other amt $ Sustaining Member $ 500.00 Building Fund, $25 or other amt $ Classes of Membership NYSAPLS LS PAC, $25 or other amt $ Class Description Total Amount Enclosed: $ Class Description Any person who is supportive of the surveying Associate Member Payment method: profession that is NOT a PLS. A PLS not registered in NYS, or a Non-licensed or a Check enclosed (Please make checks payable to NYSAPLS) Corresponding retired PLS, residing outside NYS, interested in Credit card receiving regular mailings of the Empire State Member Surveyor and other correspondence authorized by Exp. Date______________ Security Code__________ the NYSAPLS Board. Name on Card: Regular Member A registered land surveyor in the state of New York. A college or postgraduate student who is enrolled Student Member Billing Address: in a surveying program. Signature: Sustaining A firm that provides services to the land surveying Member profession. * Dues are not deductible as a charitable contribution but may be deductible as a business expense. .