Print this form, complete and send it to the address shown below.

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  Canadian Gas Processors
  Suppliers Association

Application for 2004-2005
Associate Membership

BEFORE COMPLETING THIS APPLICATION, PLEASE BE SURE YOUR 
COMPANY IS A CORPORATE MEMBER. IF IT IS NOT,
THIS APPLICATION WILL NOT BE ACCEPTED!

ALL FIELDS MUST BE COMPLETED!

NAME OF CORPORATE
MEMBER COMPANY: ________________________________________

CITY:_____________________________________________________

ASSOCIATE INFORMATION:

NAME: ____________________________________________________

YOUR COMPANY OR SUBSIDIARY:____________________________________________________

ADDRESS: __________________________________________

___________________________________________________

Telephone:___________________________   Fax: _____________________________

YOUR E-Mail: ___________________________________________________________
(Please note: your e-mail address will not be advertised - it is for the Association's
internal use only)

Each Associate Membership is
Cdn $32.10 ($30.00 + GST, Reg# R122233109)
Applicable dues must accompany application. New and renewal membership applications for 2004 will be accepted after April 1, 2004.  These memberships are valid until June 30, 2005.

    ¨ THIS IS A REVISION    ¨ THIS IS A RENEWAL               ¨ RECEIPT REQUIRED

Remit Application and Payment to:
CGPSA – c/o Bruce Parsons - Membership Director
Gas liquids Engineering ltd.
#300, 2749 - 39th Avenue NW
Calgary, Alberta, T1Y 4T8  Telephone (403) 250-2950

PLEASE VERIFY WITH YOUR ACCOUNTING DEPARTMENT THAT THIS IS THE ADDRESS THEY WILL BE USING!