There are four membership categories for the APE Research Council. Please refer to the attached membership and dues structure for definitions. (Select the appropriate category below.)

My company is appropriately placed in the following category for 2008 dues assessment:

	North American manufacturer/importer of AP or AP derivatives (e.g., APE) (Attached is a separate confidential form for reporting production numbers.)
	North American user of AP or AP derivatives (e.g., APE) - $10,000
	North American supplier of chemicals to the alkylphenol industry - $20,000
	Manufacturer, user or supplier of AP or AP derivatives (e.g., APE) outside of North America - $10,000

Research Council Representative
Name:
Title:
Company:
Address:
City:
State/Province:
Zip/Postal Code:
Country:
Phone:
Fax:
Email:
Management Contact (optional)
Name:
Title:
Company:
Address:
City:
State/Province:
Zip/Postal Code:
Country:
Phone:
Fax:
Email: