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CIPA Member Application

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Your form submission WILL be encrypted using SSL to ensure your privacy.

Please complete the form below and click Submit. Your membership will give you complete access to all CIPA's meetings, newsletters, database listings and legislative updates.

CIPA Member Application
Name: *
Company: *
Job Title *
Email: *
Phone: (xxx) xxx-xxxx *
Fax: (xxx) xxx-xxxx *
Address: *
City: *
State: *
ZIP: *
Website:


Company Description (please check all that apply)
Number of employees within your company:


Type of Membership (Check One) *

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Producers: First-time annual dues are based on prior year production of oil and gas as reported to CA Division of Oil, Gas & Geothermal Resources. Please enter your production from the prior year in the space below. ($0.114 per barrel of crude oil and $0.0151 per mcf of natural gas.)

To estimate your dues: Multiply your barrels/mcf produced yearly by the charge per barrel and/or mcf. (Example: 40,000 bbl x $.114 = $4,560 dues and 85,000 mcf x $.0151 = $1,283.50 dues ==> $5,843.50 Total Dues) 

Minimum producer dues: $920.  Dues that calculate to more than $76,100 per year fall into a special tiered dues structure.  Please call CIPA for complete details and dues calculations.

Oil Production (prior year total)
Gas Production (prior year total)
Associate Members: Dues are based on the number of employees within your organization. Please check the number of employees within your company.


How did you hear about CIPA? (Who referred you?)

    

Associate Members! List Your Company in CIPA's Buyers' Guide
Please write a brief description of the services your company provides. Limit your description to 25 words or less. We may edit (without notice) those that exceed the limit.
(Maximum characters: 250)
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Check the boxes below that best describe your company


CIPA's Monday Morning Report Delivery.
Please check a box below for your preferred method of delivery. (We encourage email delivery, which provides you with the most and fastest information and keeps our expenses down.) *

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Payment Information
Please indicate how you will be paying for your membership in the space below. Because this site is not secured, CIPA will contact you for specific payment information upon approval of your application.



Fields marked with * are required.

Your form submission WILL be encrypted using SSL to ensure your privacy.