Please print and mail this form with $65.00 payment (or $25.00 for Retired/Life members) to the DAPL Office,
535 16th Street, Suite 850, Denver, Colorado  80202, Phone: 303-446-2253, Fax: 303-595-9701

Dues must be received at the DAPL office on or before January 31st to assure continued membership in the DAPL.
Late renewals will be required to pay an additional $10.00 Reinstatement Fee.

Mr./Ms.	____________________________	____________________	_________________	____________________
	Last Name	First Name	Middle	Spouse
INDICATE IF NEW MEMBER _________			OR IF RENEWING MEMBER ________

Type of DAPL Membership:	Active ________	Associate_________	Retired/Life______________
AAPL Member?	Yes__________	No ______________	Active___ or Assoc. ______
Approved CPL?	Yes__________	No ______________	CPL #__________________
Approved CPL/ESA?	Yes__________	No ______________	CPL #__________________
Approved RLP?	Yes__________	No ______________	CPL #__________________
PLM/MLM Grad?	Yes__________	No ______________	School:________________________
Law Degree?	Yes__________	No ______________	School:________________________

We Need Your Help !
	Interested in DAPL Committee participation? Yes__________ No_______________	Preferences:_________________________________________ ____________________________________________________

 

.	Office Information	Please	Home Information
Employer:	.	fill out	.
Mailing Address:	.	both	.
Mailing Address 2:	.	columns!	.
City, State, Zip:	.		.
Telephone:	.	.	.
Fax:	.	.	.
Cell Phone:	.	.	.
Email:	(Write legibly - these are hard to read!)	.	(Write legibly - these are hard to read!)
Website:	.	.	.
	.	.	.
Send Mail to: (Check One)	Office___ or Home______	.	Directory Picture Included: Yes___No____
Years of Experience:	.	.	.
Former DAPL Member ?	Yes_____ No_____	.	If yes, which years?________
List other land association affiliations:
..
Presently are you exclusively engaged as a full time professional Landman (and have you been for a minimum of one year) primarily responsible for the acquisition, negotiation and/or management of interests in oil, gas and/or other mineral estates? Yes _____ No_____ If the answer is "No", what is your current job description?__________________________________________________
Amount enclosed: $__________ Please consider enclosing additional donation to DAPL: $____________
Signature:_________________________________________________ Date:__________________
Print Name _________________________________________
YOU MUST HAVE AN ACTIVE (NOT ASSOCIATE) DAPL SPONSOR TO BE APPROVED FOR MEMBERSHIP!
DAPL Sponsor:_____________________________________________ Date:__________________
Print Sponsor Name: _________________________________