Print this form, complete and send it to the address shown below. |
|
Canadian Gas Processors Suppliers Association |
Application for 2004-2005 Corporate Membership |
FIELDS MARKED *** MUST BE COMPLETED!
COMPANY NAME: __________________________________________________________________________ ***
ADDRESS: _________________________________________________________________________________ ***
_____________________________________________________________________________ ***
TELEPHONE : _____________________________ FAX:_____________________________ ***
WEBSITE ADDRESS:_____________________________________________________________
NAME OF PRIMARY (VOTING) REPRESENTATIVE:____________________________________ ***
E-MAIL ADDRESS:
______________________________________________________________
***
(Please note: your e-mail address will not be advertised - it is for
the Association's
internal use only)
NAME OF CONTACT FOR DISTRIBUTION OF
CGPSA ADVERTISING TO YOUR COMPANY'S STAFF
_________________________________________
E-MAIL ADDRESS OF CONTACT:
__________________________________________________________
(Please note: the Contact's e-mail address will not be advertised - it is for
the Association's
internal use only)
CHAPTER : _________________ ( North or South: Indicate North if you live/work in Western Canada north of Red Deer, AB)
Each year the Association presents safety awards in several categories (see the Safety Program page at this website). Please provide the name of your Company's Safety Representative so that we may send current information and solicit nominations for these awards. (Your Safety Rep need not be an Associate of the Association.)
NAME OF SAFETY REPRESENTATIVE:__________________________________________________
E-MAIL ADDRESS (If Available): ____________________________________________________
TELEPHONE : __________________________
| ¨Engineering Contractor ¨Consulting Engineering ¨Rotating and Reciprocating Equipment ¨Fabricator ¨Chemical Equipment and Service ¨Instrumentation, Control and Service |
¨Contractor ¨Packaged Production and Process Services ¨Thermal Equipment and Service ¨Pipe Valves and Fittings ¨Electrical Equipment and Service ¨Specialty |
Please provide a description of your products and services (limit of 20 words):
Visitors to our website will be able to search for member companies by key words, which you can provide in the space below. Select key words that will best describe your business, products or services (limit of 15 words).
_________________________________________________________________
Corporate Membership Dues (includes Primary
Representative):
Cdn $133.75
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!