Arizona Propane Gas Association

Colorado Propane Gas Association Active – Other than Retail Propane Marketer; Associate; and Individual Membership Application

I/We hereby apply for membership in the Colorado Propane Gas Association and agree to adhere to the membership standards as printed on the reverse side of this application. The category checked below represents our classification.

 ACTIVE - Any person, firm or corporation other than retail propane marketers engaged in the OTHER THAN production, distribution, sale or transportation of propane gas, and manufacturers and RETAIL PROPANE distributors of propane gas appliances or equipment, either at wholesale or retail, within the MARKETERS state of Colorado, shall be eligible to election as an Active member of this Association. This category includes voting privileges but does not include membership in the National Propane Gas Association. One Active membership per company. $300.00

 ASSOCIATE Person, firm, corporation or association not qualifying for Active membership, but interested in the purposes of the Association. This category includes voting privileges. Does not include membership in the National Propane Gas Association. One Associate membership per company. $300.00

 INDIVIDUAL Any person employed by an active member or associate member of the Colorado Propane Gas Association. This is a non-voting membership. $150.00

Nondeductible Dues: Membership dues are not deductible as charitable contributions, but may be deductible as an ordinary and necessary business expense subject to restrictions imposed as a result of association lobbying activities. Under the 1993 Federal Tax Budget Act, individuals who belong to a not-for-profit Association may not deduct for income tax purposes the portion of their membership dues spent on federal or state lobbying activities. Thus, the portion of the 2010 dues not tax deductible is 33%.

Please type or print the following:

______Company Name Accredited Representative (One Person per Company) ______Mailing Address, City/State/Zip ______Street Address, if different City/State/Zip ______Phone Number Fax Number Cell Phone ______Email Address Website URL

______TYPE OF BUSINESS: Wholesale, Transportation, Appliances, Etc. ______Signature of Applicant Your Title Date

Please return with payment to: Colorado Propane Gas Association PO Box 1425 Phone: (866) 881-6309 Lamar, CO 81052 Fax: (866) 261-4910