2009 PALTA RENEWAL/APPLICATION FOR MEMBERSHIP
Name: Are you a CPLTA? ______
Last First M.I. (Mr./Mrs./Ms.) Yes/No
Are you a member
NAME CHANGE FROM: of NALTA? ______
Yes/No
Do you want mailings to go to your Office ____ or Residence ____?
Employer: Position
Office Address: Office Phone: ( )
Fax #: E-Mail Address:
Residence Address: Home Phone: ( )
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MEMBERSHIP STATUS: Membership term is from January 1 to December 31.
______NEW MEMBER ______RENEWAL(Application must be received by January 10 or your membership will lapse.)
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TYPE OF MEMBERSHIP: Membership Status for current year is determined by this Application.
______ACTIVEAt least 3 Years employed as an Analyst: No. Years
Active Membership shall be open to any applicant directly, primarily and regularly engaged in lease and/or title work for
a cumulative period of not less than three (3) years performed within the past five (5) years at the time of application.
Lease and/or Title Analyst work defined in Article III. Paragraphs A. and B. of the By-Laws.
______ASSOCIATELess than 3 years as an Analyst
Associate Membership shall be open to any applicant having been directly, primarily and regularly engaged in lease
and/or title work for a period of less than three (3) years at the time of application.
______AFFILIATEAffiliate Membership shall be open to any applicant in the petroleum industry interested in PALTA but not directly,
primarily and/or regularly engaged in lease and title analysis
______LIFEPay half Local and National dues ($25.0 NALTA, $15 Local Chapter)
Life Membership shall be conferred upon those persons whom the Board of Directors feels have rendered outstanding
service to PALTA or made noteworthy contributions toward the establishment of lease and/or title work as a
profession.
______RETIRED LIFEPay half Local and National dues ($25.00 NALTA, $15 Local Chapter)
Any applicant who is at least fiftyfive (55) years of age, has at least twenty (20) years active experience in lease, title
or land work, is fully retired from same; and has been an Active Member for five (5) consecutive years immediately
preceding the submission of an application for Retired Life Membership status.
Reinstatement Explanation for membership lapse:
On which committee would you be willing to serve? Ethics and Grievances; Nomination; Election;Employment
Other Areas of Interest:
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Dues :______$30.00 Local Chapter $50.00 NALTA______$75.00 NALTA and Local Chapter
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Please accept my application for membership in the Permian Association of Lease and Title Analysts, Inc. If approved or renewed, I agree to abide by the By-Laws of the Association(s).
DateSignature
______
Mail Application along with a check for $75.00 for Joint PALTA/NALTA Membership or $30.00 for Permian Local Membership ONLY payable to:PALTA - Attn: PALTA Secretary - P. O. Box 10622 -Midland, TX 79702-7622
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For PALTA use only:
Date Received______Mailed Welcome Letter______
Picture for directory______Name Tag made/updated ______
Database updated______New [ ] Renewal [ ] Committee appointment ______
(Rev. 11-2007)