[Please Print and Bring this form to the next BOAFTC Meeting]

Name:
Last: ___________________________ First: ______________________ MI: _______
Title: ___________________________________ (Required)
Jurisdiction/Organization/Company: __________________________________________

Business Address:
Street: ______________________________________________________
City/State/Zip: ________________________________________________
Phone: (_____)________________ Fax: (_____)_____________________

Home Address:
Street: ______________________________________________________
City/State/Zip: ________________________________________________
Phone: (_____)_________________ Fax: (_____)____________________

Preferred Mailing Address: (Required)
Business______ Home*______

Membership Types
Active Members: Building Officials, Plans Examiners, Inspectors and government employees actively engaged in the enforcement of building, electrical, gas, mechanical, plumbing, accessibility, housing, and development of regulatory codes.
Building Official .....$50
Other employees... $10*
Retired.................. $13
* If home mailing is preferred, membership is an additional $5

Associate Members: Any research organization, academic institution, architect, engineer, contractor, manufacturer, supplier, or other individual, partnership or corporation. $55

Membership applied for: (Please check one)

____ Building Official ($50)
____ Staff - Business Mailing ($10)
____ Staff - Home Mailing ($15)
____ Retired ($13)
____ Associate ($55)
Return to:
BOATC
[Place Address Here]