revised 6/19/08

MEMBERSHIP APPLICATION

Print this page, fill in the blanks and submit with payment to: Code Enforcement Association of Texas, Attn: Lupe Guerrero, CEAT Treasurer, P.O. Box 28476, San Antonio, Texas 78228. CEAT does not accept credit cards or purchase orders, only checks, money orders and/or cash.

Date: ______________

Name: ___________________________________________________________________________

Mailing Address: ___________________________________________________________________

City, State, Zip: _____________________________________________________________________

Employer/Agency: __________________________________________________________________

Dept. or Division ___________________Position/Title: _____________________________________

Phone (with area code): ______________________________________________________________

Email: ______________________________________  Alternate Email: ________________________

DSHS Registration # CE______________________________________________________________

DSHS Registration expiration (MM/YY) __________________________________________________

County (working in, not residing in) _____________________________________________________

Referred by: _______________________________________________________________________

Signature: _________________________________________________________________________

Select One:  New Membership    Renewal
Circle One:   $40 Active         $40 Associate           $100 Member Agency
For membership information or to volunteer in the membership committee please contact Annette Rodriguez, 3^rd Vice President, City of San Antonio at ceat3vp@ceat1.org or call at 210-416-5978.

Please note that Membership Agency does not include individual memberships.  If you are interested in volunteering for the Membership Committee, please contact Annette Rodriguez, City of San Antonio by email at ceat3vp@ceat1.org or call (210) 416-5978.

***PLEASE NOTE:  Membership term is October 1 through September 30 of each calendar year***

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