the Association of Building and Zoning Code Enforcement Officers in and near Chautauqua County, New York
Western Southern Tier
Building Officials Association
Division of NYSBOC
2011 APPLICATION FOR MEMBERSHIP
|
Officers 2011
President Charles LaBarbera Town of Evans 8787 Erie Road Angola, NY 14006 Clabarberaceo@ townofevans.org
Vice President James E. Pacanowski Village of Westfield 127 Union Street Westfield, NY 14787 pacman950@yahoo.com
Treasurer Allan L. Zurawski City of Dunkirk 342 Central Ave Dunkirk, NY 14048 716-366-9858
Secretary Randy Woodbury Town of Ellicott 215 South Work Street Falconer, NY 14733 716-665-5317 buildingellicott @yahoo.com
|
Please Fill Out Completely, Type or Print
NAME__________________________HOME PHONE_______________________
MAILING ADDRESS__________________________________________________
CITY_____________________________STATE_______________ZIP__________
COUNTY__________________ NYS CERT #_________________ FDID________
WORK PHONE__________________________ FAX________________________
E-MAIL ADDRESS (indicate accurately, i.e. upper/lower case, all dots)_____________________
MUNICIPALTY / BUSINESS NAME______________________________________
POSTION OR TITLE_________________________________________________
DEDUCT $25.00 if you are a member of another NYSBOC Chapter, ie: Niagara Frontier, Finger Lakes
____ $25.00 (see above)
____ $50.00 Active Member Any individual currently certified as a New York State code enforcement official or currently employed as a code enforcement official.
____$55.00 Associate Member Any individual not certified as a New York State code enforcement official or employed as a code enforcement official.
____No Fee Honorary Member Conferred upon the individual by the membership of the organization.
APPLICANT’S SIGNATURE________________________________________________DATE___________________
Please return this form with check or voucher to:
Western Southern Tier Building Officials Association
Allan L. Zurawski, Treasurer
City of Dunkirk
342 Central Avenue
Dunkirk, NY 14048
Office use only:
Payment Received Amount $ Date: / / Check No. _Cash_____
Voucher Date __/ ___/___ _______Voucher returned ___/_ __/__ __________