ENERGY TRAFFIC ASSOCIATION (ETA)

3303 Main, Suite 207, Houston, TX 77002-9321

713-528-2868 - FAX 713-464-0702

Fed ID 75-2729885

 APPLICATION FOR MEMBERSHIP

Please accept my application for membership.

NAME                                                                                                           

COMPANY                                                                          DIVISION                                                         

TITLE                                                                                                         

MAIL ADDRESS                                                                                            

STREET ADDRESS                                                                                          

CITY, STATE, AND ZIP                                                                               

TELEPHONE                                             FAX                                     Cell                               

E-MAIL ADDRESS                                                                                         

Company Web Site (optional)                                                                 

I hereby certify that I am or am employed by a logistics provider or shipper or receiver of commodities used in the oil and gas industry (including oilfield equipment, heavy and cumbersome commodities and other similar or related commodities or supplies).  I understand that membership in ETA is open to those who provide services to the petroleum or related industries including all types of size and weight commodities of all sizes and shapes.

Annual membership dues __$75 per individual, or __$150 per company.  Company memberships cover up to four employees of the same division at the same location.

       My dues check is enclosed, or        Bill my credit card as follows

Type Card:  (   ) Amex      (   ) MC      (   ) Visa      (   )Discover

Credit Card No                                                                Exp. _____/______

Billing  Address or POB                                                                        Zip                        

Call me at the above number for card security code.

Signed                                                                 Date:                        

Company membership to include the following at the same address

Name                                                                Title                                     Email                                         

Name                                                                Title                                     Email                                         

Name                                                                Title                                     Email