INOGA - Become a Member

Become an INOGA Member

2009 Membership Dues Statement

Please complete this form and send with check to INOGA, Attn: CJ Mayhew, Membership Chairman, 6508 S. Uebelhack Rd., Mt. Vernon, IN 47620

Company	_______________________________________________
Contact Person	_______________________________________________
Address	_______________________________________________
Phone	_______________________________________________
Cell Phone	_______________________________________________
E-Mail	_______________________________________________

Do you want information e-mailed to you? YES NO

Make checks payable to Indiana OGA. Your 2008 dues are from January 1 – December 3.

Please check the one that applies to your Company:

Producer	_____	Pipeline	_____
Service/Supply	_____	Gas	_____
Geologist	_____	Engineer	_____
Attorney	_____	Other(Specify)	_____

2009 DUES

2009 DUES $75.00 per person (voting member, no limit on number per company)

$25.00 per person (additional non-voting member per Company)

Dues include membership to the Oil & Gas Reporter

______ Yes, I would like to receive the Oil & Gas Reporter Magazine

______ No, I would not like to receive the Oil & Gas Reporter Magazine

(Multiple members from a company may become voting members if they choose to pay the full $75 membership fee; $3 of each paid membership goes directly into Scholarship Fund)

Extra Donation: ______________

Total Enclosed: ______________