Ethanol Producers And Consumers Membership Form

(Download a Microsoft Word version of this form here.)

(Download an Adobe Acrobat version of this form here.)

Five great reasons to be a member:

1 Be part of a well-known, highly-respected, international Ethanol advocacy group.

2 Discount on conference registration.

3 Receive EPAC newsletter, keeping you up-to-date on Ethanol happenings and be on EPAC’s email distribution list.

4 Opportunity to be listed as a member on the EPAC website and/or have a link to your website from the EPAC website.

5 Discount on advertising in the EPAC newsletter and website.

Yes, I want to become a member (membership year runs from Oct. 1 through Nov. 31).

Enclosed are dues:
VIP $2,000 and up _______
Corporate $1,500 ________
Support $750 ________
Sponsor $200 ________
Individual $50 ________
Donation for projects ________

Contact Name: ______________________________________________________
Business Name: ______________________________________________________
Mailing Address: ______________________________________________________
City, State, Zip: ______________________________________________________
Phone: _________________________ Fax: _________________________
Email: ___________________________________________________________

Do you want your email address listed on EPAC’s website? YES____ NO____

Do you want your website listed on EPAC’s website as a link? YES____ NO____

Website: ___________________________________________________________

Payment Information

_ Check enclosed, U.S. funds (Make payable to EPAC)
_ Visa     _ MasterCard            Card #_______________________________________

Exp. Date_____________

Name on card_________________________________ Signature____________________________________

Mail this form with payment to:

EPAC
172 Ball road
Nashua, MT 59248
Ph: 406-785-3722 Fax: 406-785-2252
Email: epac@ethanolmt.org