Association of Professional Engineers and Geoscientists of BC

Application for Deferral of Annual Fees

All information will be kept in strict confidence

Name of Applicant ____________________________________________________________________________
Association Membership Number (or six-digit System ID) ____________________________________________
Complete Address ____________________________________________________________________________
Telephone _______________________________ (Day) ___________________________________ (Evening)
Are you presently employed as an Engineer or Geoscientist? Yes No

Are you employed elsewhere? Yes No

What is your Annual Active Income*? $_________________________
*Annual Active Income includes gross income from all employment or director's fees and/or net income from self-
employment; it does not include pension or other retirement income, investment income, unemployment insurance
income, support payments, other government allowances, scholarships, bursaries, or disability income. All other sources of
income are considered "active."

Declaration

I request deferral of my Annual Fees for a maximum of one year.

At the end of one year, I will be obliged to choose one of the following options:
1. I will pay the deferred annual fee to APEGBC;
2. I will make a full application to the APEGBC Engineers and Geoscientists Benevolent Fund for
assistance; or
3. I will resign my membership with APEGBC.


Please attach a copy of your rsum.
Mark Confidential and send to: _________________________________________
Director, Registration (Signature of Applicant)
APEGBC
200 4010 Regent Street Date _____________________________________
Burnaby, BC V5C 6N2
gpichler@apeg.bc.ca

If you require additional financial assistance, please contact Tim Verigin, Member Services Coordinator tverigin@apeg.bc.ca
or go to http://www.apeg.bc.ca/services/benevolentfund.html to make an application for financial assistance to the
Engineers and Geoscientists Benevolent Fund.






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