Membership Application

Company Name

Type of Company (Products manufactured, services provided, etc.)

Oklahoma Location(s)

City

State

Zip

Primary Contact Name (for benefit fulfillment and billing purposes)

Title

Office Phone

Mobile

Website

Primary Contact Email

Secondary Contact Name

Secondary Contact Title

Secondary Contact Address

City

State

Zip

Secondary Office Phone

Secondary Mobile Phone

Secondary Email

Additional #1 Name

Additional #1 Title

Additional #1 Office Phone

Additional #1 Mobile

Additional #1 Email

Additional #2 Name

Additional #2 Title

Additional #2 Office Phone

Additional #2 Mobile Phone

Additional #2 Email

Membership Dues Membership Dues Company (3 or more facilites) $6000 Company (2 facilities) $5000 Company (1 facility) $2500 Company - Oil & Gas E&P only $1200 Associate $600 Appendix Affiliate $500

Payment Options Payment Options Bill my Credit Card (EFO will invoice electronically) Check P.O Number - (requires documentation of purchase order attached)

Please list check number or P.O number here, Thank you.

Environmental Permits - Air Environmental Permits - Air Major Air GHG RMP Minor Air - Multiple Minor Air - Single PBR Permits

Environmental Permits - Water Environmental Permits - Water NPDES SWPPP UIC OTHER

Environmental Permits - Solid & Hazardous Waste Environmental Permits - Solid & Hazardous Waste Solid Waste TSDF Hazardous Waste Other

Environmental Permits - other Environmental Permits - other Wildlife Corporation commission Health & Safety

Organizational Committees Organizational Committees Legislative Activities