Membership Application

Company Name

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

Oklahoma Location(s)

City

State

Zip

Phone Number

Website

Primary Contact Name (for benefit fulfillment and billing purposes)

Title

Office Phone

Mobile

Email Address

Secondary Contact Name

Secondary Contact Title

Secondary Office Phone

Secondary Mobile Phone

Secondary Email

Additional Name #1

Additional Title #1

Additional Office Phone #1

Additional Mobile Phone #1

Additional Email #1

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 Affiliate $500 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

Environmental Permits - EFO Committee Interests Environmental Permits - EFO Committee Interests Legislative Activities