<p> PEGNL CONSULTING ENGINEERING AND GEOSCIENCE SERVICES LISTING FORM</p><p>1. Your Firm/Organization Company Name: </p><p>Contact Person: </p><p>Position: </p><p>Address: </p><p>Telephone: ( ) Website Address: Fax: ( ) E-Mail: </p><p>2. Size of Organization: Full Time Part Time </p><p>Professional Engineers (P. Eng.) ____ Professional Geoscientists (P. Geo.) ____ Technicians/Technologists ____ Other Support Staff ____ Total ____ </p><p>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)</p><p>1. Discipline 2. Discipline ______</p><p>*Sub-Disciplines *Sub-Disciplines ______</p><p>Other Other ______</p><p>Continued on reverse  </p><p>Professional Engineers and Geoscientists Newfoundland and Labrador 3. Discipline 4. Discipline ______</p><p>*Sub-Disciplines *Sub-Disciplines ______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>Other Other ______</p><p>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. </p><p>5. Your firm has ISO certification? Yes ____ No ____ </p><p>6. Are you a member of Consulting Engineers of Newfoundland and Labrador?</p><p>Yes No _____ </p><p>7. Are you presently exporting your services - outside this province? Yes ____ No ___</p><p>If yes, where ______</p><p>Outside of Canada? Yes ___ No ___If yes, where ______</p><p>Return by fax to: (709) 753-6131 or by mail to:</p><p>PEGNL - Consulting Services Directory P.O. Box 21207 St. John's, NL A1A 5B2</p><p>Professional Engineers and Geoscientists Newfoundland and Labrador</p>