Text Box: P.O. Box 61629 Houston, TX 77208-1629

 2008 Membership Application

NAME PHONE        
COMPANY FAX
ADDRESS E-MAIL
  YAHOO ID
  BIRTH DATE

Please  state  the  type  of  distribution  and  for  which  gas  liquid  products  you  coordinate movement:

GET INVOLVED!!  The following committees will need members – please indicate those on which you would like to serve:

 House         Program/Membership         Golf   

 

Event ideas:                                       

Out-of-Houston event plus location:   

Program and Speaker ideas:               

 
(PLEASE NOTE IF YOU ARE GOING TO PAY USING PAY PAL YOU NEED TO ADD $.30 TO THE TOTAL AMOUNT YOU ARE GOING TO BE PAYING. THIS IS A PER TRANSACTION FEE THAT PAY PAL IS CHARGING US.)
 
(EX: $25.00 + $.30 = $25.30)
 
pay by Pay Pal

(PLEASE NOTE THERE IS A 2.9% SERVICE CHARGE FOR USING PAY PAL. THIS WILL AUTOMATICALLY BE INCLUDED WHEN YOU CHECK OUT. THIS WILL SHOW UP AS A SHIPPING AND HANDLING FEE.)

pay by check

Total Amount :                        

v     Please return this form and annual dues of $25.00 payable to the GLDA to the above address by Wednesday, February 29, 2008 in order to receive all bulletins for the 2008 meetings and GREAT activities.

v     THE ANNUAL FEE FOR APPLICATIONS RECEIVED AFTER THE ABOVE DATE WILL BE $35.00 – UNLESS THE APPLICANT IS NEW TO THE INDUSTRY.  

v     Please pass this application on to any new prospective member.

At coming events sponsored by the GLDA, alcoholic beverages may be made available for participants discretionary consumption.  Upon submission of this membership application, the GLDA hereby expressly disclaims any liability whatsoever that may arise from any participant's consumption of alcoholic beverages and any claims, losses, damages, causes of action, suits, and liability of every kind, whether willful or negligent, for injury to or death of any person, including any participant, or for damage to any property, arising out of or in connection with any participant's discretionary consumption of alcoholic beverages or for any other reason.