Company Name. Company Rep. Title. Address. City State Zip. Phone # ( ) Fax # ( ) Toll Free Phone # ( ) Website

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1 FPGA/NPGA ACTIVE INTRASTATE DEALER 2017 MEMBERSHIP APPLICATION Please complete and return this form along with your MC, Visa or check made payable to: FLORIDA PROPANE GAS ASSOCIATION, P.O. BOX 11026, TALLAHASSEE, FL tel (850) , fax (850) Company Name Company Rep. Title Address City State Zip Phone # ( ) Fax # ( ) Toll Free Phone # ( ) Website FPGA/NPGA ACTIVE DEALER MEMBERSHIP DUES INVESTMENT FPGA Base Dues Structure: Under 300,000 annual gallons $ ,500,001 3,000,000 annual gallons $2, , ,000 annual gallons $ ,000,001 5,000,000 annual gallons $3, ,001 1,000,000 annual gallons $1, ,000,001-7,000,000 annual gallons $5, ,000,001 1,500,000 annual gallons $1, ,000,001 and over annual gallons $6, (Dealer retail annual gallons sold in Florida for the calendar year January 1, December 31, 2016) FPGA Base Dues: (Based on dues structure above) $ # of Florida Branch Locations $ per branch over 1 branch $ (Please list each branch location on BRANCH INFO sheet attached-(required) NPGA Bulk Plant Dues: 0 2 Bulk Plants or Headquarters $ Bulk Plants - $270 (additional combined price) $ 6+ Bulk Plants - $256 (per additional bulk plant) $ (Please list each bulk plant location on BULK PLANT INFO sheet attached-(required) Florida Propane Political Action Committee Contribution (Optional)-(Brochure Attached) $ Committee of 100 Contribution (Optional): $ TOTAL 2017 DUES $ CHECK ENCLOSED MASTERCARD/VISA# EXPIRATION DATE: SECURITY CODE: CARD BILLING ADDRESS: ZIP CODE: Enclosed is my application as an active dealer member in the FPGA/NPGA. I certify that my company meets the definition of an active member as established by the FPGA Constitution. Signature Date Payments to the FPGA/NPGA are not tax-deductible as charitable contributions for federal income tax purposes. However, they may be deductible as ordinary and necessary business expenses, subject to restrictions imposed as a result of association lobbying expenses. The non-deductible dues portion for lobbying expense in 2017 is estimated to be 20% for the FPGA and 17% for the NPGA.

2 MULTI-BULK PLANT INFORMATION SHEET (REQUIRED) For Member Profile (make copies if additional spaces are needed) Multi-Bulk Plants #1: Bulk Plant Manager Name #2: Bulk Plant Manager Name #3: Bulk Plant Manager Name #4: Bulk Plant Manager Name

3 Branches BRANCH INFORMATION SHEET (REQUIRED) For Member Listing in the FPGA Membership Directory and Mailings (make copies if additional spaces are needed) #1: Branch Manager Name #2: Branch Manager Name #3: Branch Manager Name #4: Branch Manager Name

4 FPGA MEMBERSHIP GENERAL DEALER INFORMATION DUES: Annual dues for members shall be payable in advance of the first day of January each year. Dues shall be made payable and forwarded to: Florida Propane Gas Association P.O. Box Tallahassee, FL FPGA/NPGA Affiliation with the National Propane Gas Association: Under the authority of Article VI of the FPGA Constitution, the Executive Board has executed an affiliation agreement with National Propane Gas Association, Inc. (NPGA). The agreement is known as the State Charter Affiliation Plan as given in the constitution of NPGA, Inc. Under this affiliation agreement all Active intrastate members of the FPGA, become members of NPGA, Inc. upon payment of dues to the FPGA. FPGA pays a portion of members dues to NPGA for membership of each Active Member. What is a bulk plant under the NPGA rules? A bulk plant is defined as any facility where the primary function is to store LP-Gas prior to further distribution, where LP-Gas is received by cargo tank motor vehicle, railroad tank car, or pipeline, and then distributed by portable container (package) delivery, by cargo tank motor vehicle, or through gas piping. A facility distributing gas through gas piping, such as a community gas system, is exempt from the definition of a bulk plant unless the facility is used to transfer product into cargo tank motor vehicles for further distribution.

5 FPGA MEMBERSHIP SERVICES NPGA Florida Propane Gas Association provides extensive membership services. The following is a small sample of the variety of services available: Inclusion in and copy of the FPGA Annual Membership Directory listing all FPGA committees, dealers and supplier companies doing business in Florida Subscription to the bi-monthly Florida Propane Gas Association s digital magazine, providing timely information and an outlet for advertisers Monthly blasts of the ENews, our associations electronic newsletter Discount on supplies for resale, including meter tickets, decals, signs, pamphlets, educational and safety products, NFPA books, NFPA Gas Codes, invoices and envelopes Discounted registration for meetings and conventions for the dissemination of industry information Education: Discounts on year-round training facility and service school, safety workshops, sales seminars, management workshops and certified employee training Active state lobbying efforts by Legislative Committee and Lobbyist Political Action Committee contribution opportunities State and national marketing programs Propane gas industry information Access to all NPGA resources, federal legislation efforts, research and development, safety and educational training, and national promotion Technical assistance and information And Much More! IT PAYS TO BE A MEMBER