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NEW MEMBER APPLICATION

Green Mountain Locksmith’s Association
Application for membership
Please print or type all information
Date____________ I, ________________________ _____________________ ___________________________
(LAST) (FIRST) (MIDDLE)
Hereby apply for membership in the Green Mountain Locksmith’s Association.
Home address: _____________________________ ______________________ _______________ __________
(Street) (Town) (State) (Zip)
Telephone # (_____) ________ - ______________ Citizenship ________________ Date of birth ______________
Are you actively involved in the locksmith trade? ____ Full Time? _____ Part Time? ______ How Long _________
Business Name ______________________________________________________________________________
Business Address _______________ ___________________________ ______________ ___________________
(Street) (Town) (State) (Zip)
Telephone # (_____) ________ - ______________ Contact Person _____________________________________
How did you receive your training? ________________________________________________________________
List Locksmith Association Memberships: ___________________________________________________________
Have you ever been convicted of a felony? __________________________________________________________
Character References:
Name_____________________________________________________________ Tel. # _____________________
Address: _____________________________________________________________________________________
Name_____________________________________________________________ Tel. # _____________________
Address: _____________________________________________________________________________________
Business References:
Name_____________________________________________________________ Tel. # _____________________
Address: _____________________________________________________________________________________
Page 1 of 2
Name_____________________________________________________________ Tel. # _____________________
Address: _____________________________________________________________________________________
Sponsor _______________________________Signature of Sponsor _____________________________________
Must be a regular member of GMLA
Type of membership applied for:
Apprentice: _______ this is to certify that I am currently employed, engaged or a student in the Locksmith industry.
Regular: _________ this is to certify that I have been actively engaged in the locksmith profession for a period of not less than two years.
This application must be accompanied by a non-refundable application fee of $50.00 and the initial annual dues of $75.00. TOTAL DUE WITH APPLICATION $125.00
I, __________________________________ hereby certify that the preceding statements are true and correct to the best of my knowledge, and, if accepted as a member, I agree to abide by the rules, regulations and code of ethics of the Green Mountain Locksmiths’ Association. I further agree to return my membership card and all insignia upon termination of my membership in the GMLA.
I agree to provide the required information for the completion of a background check.


Signature ______________________________________________________________ Date: _________________

Notary Public __________________________________________________________________________________
My Commission Expires,_____________________________________
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When all sections are completed return this
Application with a check for $125.00 Payable to The
Green Mountain Locksmith’s Association Inc.
C/o George Gardner
884 Old Hollow Road
North Ferrisburg, VT 05473

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