Ditt/Apegn/Cenl

PEGNL CONSULTING ENGINEERING AND GEOSCIENCE SERVICES LISTING FORM

1. Your Firm/Organization Company Name:

Contact Person:

Position:

Address:

Telephone: ( ) Website Address: Fax: ( ) E-Mail:

2. Size of Organization: Full Time Part Time

Professional Engineers (P. Eng.) ____ Professional Geoscientists (P. Geo.) ____ Technicians/Technologists ____ Other Support Staff ____ Total ____

3. Permit Holder's Authorized Discipline(s) of Practice and specialty/sub-disciplines. LIST ONLY DISCIPLINES FOR WHICH YOUR FIRM HAS BEEN AUTHORIZED TO PRACTICE BY PEGNL. (Note: Please refer to those specialty/sub-disciplines listed under your authorized discipline in Appendix A)

1. Discipline 2. Discipline ______

*Sub-Disciplines *Sub-Disciplines ______

Other Other ______

Continued on reverse 

Professional Engineers and Geoscientists Newfoundland and Labrador 3. Discipline 4. Discipline ______

*Sub-Disciplines *Sub-Disciplines ______

______

Other Other ______

4. Description of Professional Services. Each firm will be provided a maximum of one-half page so please be brief as your description will require editing if it extends beyond this.

5. Your firm has ISO certification? Yes ____ No ____

6. Are you a member of Consulting Engineers of Newfoundland and Labrador?

Yes No _____

7. Are you presently exporting your services - outside this province? Yes ____ No ___

If yes, where ______

Outside of Canada? Yes ___ No ___If yes, where ______

Return by fax to: (709) 753-6131 or by mail to:

PEGNL - Consulting Services Directory P.O. Box 21207 St. John's, NL A1A 5B2

Professional Engineers and Geoscientists Newfoundland and Labrador