PermitTechNation 2020 Membership Application
PermitTechNation welcomes your application for membership. A copy of our current W-9 is available via this link
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Is this a new application or renewal?
If registering as an Individual Member, Individual Corporate or Corporate Member, please indicate the name of your Jurisdiction or Company. If you are registering a Chapter for membership, please indicate the name of the Chapter.
Name of Jurisdiction/State Chapter/Company you are registering under?
State (abbreviation only please)
Telephone # (xxx-xxx-xxxx format only please)
Email Address of Member or Chapter Representative
Chapter Voting Member Designee (enter first & last name of voting designee if filing for Chapter Membership)
Are you an ICC Member?
If you are an ICC Member, what is your member#
Are you an ICC Certified Permit Technician?
Individual Member- You must be currently employed by a political subdivision or municipality for this membership type. Fee is $25
Chapter Membership - Any Association or Chapter whose members are employed by/for a governmental entity that is actively engaged in the administration and enforcement of building codes and all related ordinances. Please designate your voting member above. Fee is $100
Individual Corporate Membership: Any individual who works for an organization such as an association, society, testing laboratory, institute, university, college, company, manufacturer, or corporation interested in the purpose and the objectives of PermitTechNation. Fee is $50.00
Corporate Membership: Any organization such as an association, society, testing laboratory, institute, university, college, company, manufacturer, or corporation interested in the purpose and the objectives of PermitTechNation. Fee is $300
Special Membership: Special memberships may include but are not limited to Honorary Member, Retired Member and Student/Intern Member. (Must be approved by Board of Directors)
I am applying for the following membership type
Individual Membership $25.00
Chapter Membership $100.00
Individual Corporate Membership $50.00
Corporate Membership $300.00
I wish to pay via
Check Out Procedures
When paying via Check or Purchase Order, please print your email copy of the response and mail with the payment.
Dawn Neil, PTN Treasurer
c/o Bernards Township Building Dept.
277 S Maple Ave
Basking Ridge, NJ 07920
If paying via Credit Card please click the appropriate checkout link below; indicate the name of the PAYER (name of who the credit card belongs to) below so we can match the payment to the member.
For credit card payments indicate name of payer below ie: City of Sample or John Doe
CREDIT CARD PAYMENTS-Choose one of the following links to pay by credit card. Please note you must be in either Chrome/Safari/Firefox, IE isn't supported.
Individual Membership -
Individual Corporate Membership-
A copy of your responses will be emailed to the address you provided.
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This form was created inside of Dawn Neil.