North Carolina Locksmiths Association 
Application for Membership
Applicant Section 
Full Name 	
Street Address 	 
	City ___________________________State 	 Zip Code_____________ 
	Home phone 	Business phone _____________________ 
	Date of Birth ________________________	NC Locksmith License # _______________  
	Have you ever been convicted of a criminal or felonious offense? Yes 	No 
If yes, please explain on reverse or on separate page. 
	How long have you worked in the locksmith trade? 	
Are you a member of any other professional security organization? If so, list organization name and membership number: ___________________________________________________
________________________________________________________________________

Applicant's Signature _______________________________	Date _________________ 

Sponsor Section 

Sponsor Name _________________________________________ NCLA# __________ 	 
	Please share any information you can about the applicant: 	
_______________________________________________________________________
_______________________________________________________________________
OFFICE USE ONLY 
Application Fee 	Dues 	Membership # 	Date 	 

Regular	Apprentice	Junior	  Honorary	Associate	Committee Decision_______

Remit to:						1. $10 application fee.
							2. A Criminal Records Check from all 
NCLA Membership					jurisdictions you have resided in for the 
Gary West						last 5 years.  Criminal records check is 
1 Brackenwood Ct					waived for junior membership.
Greensboro, NC  27407				3. A photocopy of a valid state Locksmith    
							License or proof that you are practicing 
Application is due 30 days before meeting		locksmithing.
and must include the following:			4. A photograph 3" x 3", Head & Shoulders,
							made within (30) thirty days of application.