WPGA Membership Application

Transcription

1 WPGA Membership Application Physical Address City State Zip Code Phone Fax County Web URL City State Zip Code Phone Fax County * Web URL Accredited Representative Phone Fax *An address is required to receive WPGA s News & Notes publication Member Classification Class A Retail Marketer of Propane Class B Producers, Refiners, Brokers, Agents and Transporters of Propane Class C Manufacturers, Wholesalers, Distributors and/or Dealers in Propane Equipment, Appliances and Containers Class D Fabricators of Equipment for the Propane Industry Class E Associate Members Class F Dispenser Operators, Individual Members and Out of State Marketers Dues Category (fill in blank) Class A - Class C - Class D - For this information, please refer to the WPGA Dues Structure form. For a more detailed description of membership classifications, as well as membership fees, please refer to the WPGA Dues Structure form. Employees to add to WPGA s mailing list (use additional sheets if necessary) Contact City, State, Zip Phone Fax Contact City, State, Zip Phone Fax Please submit this form to WPGA s Membership Department Mail: Western Propane Gas Association (916) H Street, Suite 203 info@westernpga.org Sacramento, CA Questions: (916) I certify that the information I have provided on this application is correct. Company Representative Date

2 CATEGORY WPGA s 2016 Dues Structure GALLONS SOLD LAST YEAR CLASS A-Retail Marketers of Propane ANNUAL DUES CATEGORY GALLONS SOLD LAST YEAR ANNUAL DUES A Up to 1 Million $775 I Million $7,625 B Million $1,450 J Million $11,160 C Million $1,950 K Million $17,125 D Million $2,460 L Million $25,000 E Million $2,985 M Million $30,000 F 3-5 Million $4,325 N Over 100 Million G 5-8 Million $5,175 H 8-12 Million $6,100 CLASS B- Producers, Refiners, Brokers, Agents and Transporters of Propane Flat Rate - $2,100 $45,000 CLASS C-Manufacturers, Wholesalers, Distributors, and/or Dealers in Propane Equipment, Appliances and Containers (Annual Gross Sales in California for Past Calendar Year) CATEGORY GROSS SALES ANNUAL DUES CATEGORY GROSS SALES ANNUAL DUES 1 Less than $1,150 3 More than $3,250 $500,000 $800,000 2 $500, ,000 $2,200 4 Not doing business in California but want to $300 CLASS D-Fabricators of Equipment for the Propane Industry CATEGORY GROSS SALES DUES A Less than $500,000 $550 B $500, ,000 $650 C More than $700,000 $750 CLASS E-Associate Members Flat Rate - $700 CLASS F-Dispenser Operators, Individual Members and Out of State (Non-Voting Class) Flat Rate - $175

3 MEMBERSHIP APPLICATION INTRASTATE MARKETER Please type or print clearly. All information must be provided to avoid processing delays. : Physical Address (required*): City: State: Zip Code: Web URL: : City: State: Zip Code: Web URL: Accredited Representative: *NPGA must have this address to send a membership plaque. Please provide the fax # and/or address. NPGA no longer sends NPGA reports via regular mail. Without a fax # or , we cannot send the NPGA report to the member. Bulk Plant Only Retail Location Only Bulk Plant & Retail Location Check here if bulk plant is also retail location and should be listed in NPGA s Membership Directory. Member Classification: Headquarters Only Check here to list HO in NPGA Membership Directory. Office Only Check here to list Office in NPGA Membership Directory. Member Type (please check one): New Member (first-time) Reinstate (former) Member ADDITIONAL RETAIL OUTLETS OR BULK PLANTS (use additional sheets if necessary) Primary Contact: Primary Contact: : (if different than above) : (if different than above) : Physical Address: Bulk Plant Only Retail Location Only Bulk Plant & Retail Location Check here if bulk plant is also retail location and should be listed in NPGA s Membership Directory. : Physical Address: Bulk Plant Only Retail Location Only Bulk Plant & Retail Location Check here if bulk plant is also retail location and should be listed in NPGA s Membership Directory. Please submit this form to WPGA s Membership Department: (916) info@westernpga.org Questions? Call (916) Mail: WPGA Membership Department 2012 H Street, Suite 203 Sacramento, CA COMPANY NAME: Association Representative: Date:

4 NPGA MEMBERSHIP CATEGORIES & 2016 DUES MARKETERS Sell propane to customers INTRASTATE Primarily located in one state INTERSTATE 15+ retail locations with 7+ outside HQ state MLP MULTISTATE JOIN THROUGH STATE JOIN THROUGH NPGA NPGA Marketers Dues Structure 0 2 bulk plants or headquarters $ bulk plants (additional combined price) $ bulk plants (per additional bulk plant) $256 A company with 2 bulk plants pays $498 in NPGA dues. A company with 5 bulk plants pays $768 ($498 + $270). A company with 30 bulk plants pays $768 for plants 1 5 and $6,400 for plants 6 30, for a grand total of $7,168. NPGA MLP Multistate Marketers Dues Structure The total MLP multistate marketers dues will be allocated by the percentage to the combined total of retail gallons sold as reported on the most recent fiscal year SEC 10-K filing for each MLP. Base dues for the MLPs were established in Adjustments to the total base dues amount will be made to account for acquisitions of other marketer companies by the MLP multistate marketers as well as any dues percentage increase approved by the Executive Committee or Board of Directors. SUPPLIERS Offer goods & services to marketers OTHER MEMBER TYPES JOIN NPGA DIRECTLY Producer/Broker/Wholesaler of LP-Gas Schedule 1 Schedule 2 Small: 1 2 states $1,352 (PS) Appliance Manufacturer Carburetion Installer Medium: 3 6 states $3,560 (PM) Container Manufacturer Insurance Agency Regional: 7 12 states $7,118 (PG) Equipment Manufacturer Manufacturer s Rep Large: 13+ states $17,795 (PH) Storage/Pipeline Transporter Truck Transporter Services Vehicle Fabricator Business Services Wholesale Distributor International Company $357 Consulting Appliances Foreign operations/all business is outside the U.S. Insurance Carrier/Underwriter Containers Technology Provider, etc. Equipment Retired $142 Retired persons from a member company LP-Gas Industry Gross Income Annual Investment Schedule 1 Schedule 2 Individual Less than $2.5 million 1. $1,352 A. $1,352 Current employee of a member company Over $2.5 - $5 million 2. $3,560 B. $2,135 Grassroots advocate/pac eligible Over $5 - $7.5 million 3. $7,118 C. $3,560 Over $7.5 - $10 million 4. $14,236 D. $4,982 Over $10 million 5. $17,795 E. $5,695

5 WPGA/NPGA Dues Statement Completion of the WPGA and NPGA Membership Applications are required before completing this form. Please fill in the section(s) below that applies to your company. To determine your WPGA membership classification, category and dues, refer to the WPGA Dues Structure form. Please return all forms, once completed, along with your dues payment to the WPGA Membership Department (see contact information below). NPGA dues are based on the number of bulk plant facilities operated by your company (see below). To help you determine which of your locations qualify as a bulk plant, NPGA has provided the following definition 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. WPGA Dues Membership Classification Membership Category (if applicable) Membership Dues NPGA Dues (NPGA membership ONLY applies to Class A Marketers). Total Number of Bulk Plants $498 for zero, one or two bulk plants $768 for three, four or five bulk plants $1024 for six bulk plants If greater than six, please refer to the attached NPGA Dues Schedule. Membership Dues Payment Information Company Accredited Rep Phone Fax Method of Payment Check Visa MasterCard Cardholder Signature Total Amount Enclosed Card Number Expiration Date Please complete this form and return it by mail or fax to: WPGA: 2012 H Street, Suite 203, Sacramento, CA / Fax (916)

6 Join the Ranks of Industry Leadership AS A WPGA COMMITTEE MEMBER Request for Committee Appointment Contact City, State, Zip Phone Company Fax Website I would like to serve on the following committee(s): Clean Fuels Communications & Membership Services Convention Safety, Education, Codes & Regulations Governmental Affairs CLEAN FUELS This committee monitors and interprets rule changes that affect carburetion standards, the LPG fuel specifications, emission regulation and air district rules/program. In addition the committee provides direction and follows through in such areas as product development, input on standards, proper installation of procedures and service techniques, input on legislative matters, and promotion relative to LP-Gas as an engine fuel. COMMUNICATIONS & MEMBERSHIP SERVICES The committee is responsible for monitoring the internal publications and communications of the association, as well as coordinating and promoting programs to educate the public on the value of propane as a valuable component of the business, industrial and residential community. The committee s further objective is to coordinate with the staff and Board all membership recruitment and retention activity. CONVENTION This committee s work involves planning the WPGA s Annual Convention and Trade Show. The committee s specific tasks are planning the program and related activities, promotion of the event, and recommending policies for the convention and trade show. GOVERNMENTAL AFFAIRS The committee s scope shall be to maintain liaison with and furnish industry information and cooperation to governmental agencies, to consider and recommend policy on legislation affecting the industry, to maintain liaison with other organizations and associations in the filed of governmental relations, and to formulate and recommend model laws and ordinances for our association s sponsorship. SAFETY, EDUCATION, CODES & REGULATIONS This committee researches ideas and methods of presenting educational and safety programs to the membership. The committee works closely with state agencies such as the California Public Utilities Commission, the Department of Industrial Relations, State Fire Marshal, California Department of Forestry and fire departments throughout the state. The committee also works with other organizations concerned with transportation. Please submit this form to WPGA Mail: Western Propane Gas Association (916) H Street, Suite 203 info@westernpga.org Sacramento, CA Questions: (916)