Please print this form, fill it out, and mail it to the address shown below.

Association of Title Examiners
Membership Application

Name: ________________________________________________________________________
              (FIRST)        (MIDDLE)        (LAST)  
Home
Address: _____________________________________________________________________
                    (NUMBER)  (STREET)          (CITY)       (STATE)     (ZIP)

Phone Number: Home ________________________ Business _________________________ 

E-Mail: ________________________________________ Fax _________________________


Employer's Firm Name: ________________________________________________________

Employer's Address: __________________________________________________________
                    (NUMBER)  (STREET)          (CITY)       (STATE)     (ZIP)

Date Employed: _______________ Name of Superior: _____________________________

Your Job Title: _______________ Business of Employer: ________________________

Professional Experience: _____________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Professional Education: ______________________________________________________

______________________________________________________________________________

______________________________________________________________________________

References - Business associates having knowledge of your qualifications:

	Name		    Occupation	        Company           Address

________________________ _________________ _________________ _________________

________________________ _________________ _________________ _________________

________________________ _________________ _________________ _________________


Memberships: _______________________________________________

             _______________________________________________

             _______________________________________________


I am enclosing an application fee of $40.00, which I understand will be refunded
if I do not qualify for membership.  I am aware that the annual dues of the 
Association are currently $40.00.

I hereby agree, if accepted to membership, to abide by the Constitution and
By-Law of the Association of Title Examiners.


Your Signature: ___________________________________ Date: ____________________


Return with appropriate membership dues to:

Association of Title Examiners
c/o David C. Jenkins
Martin Law Offices, LLP
423 McFarlan Road
Kennett Square, PA 19348

make checks payable to Association of Title Examiners

Please send mail to:  Home ____       Business ____