SOUTH CAROLINA PERMIT TECHNICIAN ASSOCIATION 
P.O. BOX 2468 MYRTLE BEACH, SOUTH CAROLINA 29578 
Phone: (843) 918-1163 Fax: (843) 918-1158 
NAME:__________________________TITLE:___________________________ 
REPRESENTING:__________________________________________________ 
MAILING 
ADDRESS:_______________________________________________________ 
Street or P.O. Box 
________________________________________________________________ 
City State Zip Code 
ICC MEMBRSHIP # _________________________________ 
PHONE: ( ____ )____________ EXT: ____ _________ 
FAX: ( ____) ________________________________
E-MAILADDRESS:________________________________________________
CHECK 
ONE MEMBERSHIP CLASSIFICATION ANNUAL DUES 
. 
. 
...... 
ACTIVE MEMBER - A designated representative of a Governmental Agency 
engaged in the administration of codes, laws, and ordinances relating to 
building construction. 
$10.00 (1 per jurisdiction) 
( ) 
2ND ACTIVE MEMBER - Any additional member from Governmental Agency 
engaged in the administration of codes, laws, and ordinances relating to 
building construction. 
$5.00 
( ) 
PROFESSIONAL/ASSOCIATE MEMBER -An individual or firm interested in the 
objectives of the Association. 
$15.00 
( ) 
STUDENT MEMBER - A student enrolled in construction, engineering, 
architecture, or related field of study and interested in the objectives of the 
Association. 
$10.00 
( ) RETIRED MEMBER– Any former member who is retired. $10.00 
Signature:_________________________________________________ 
Date:___________________