APPLICATION FOR SUPPLIERS MEMBERSHIP
(Annual Dues $1,500.00)

I hereby apply for membership as a Supplier Member and qualify in accordance with Section 2.2(b)(1) of the Bylaws, "Any partnership, company or corporation which is engaged in the business of manufacturing and supplying to gasket fabricators, raw materials, equipment, services or supplies of any form or description may be elected to Supplier Membership, upon such terms and conditions and the payment of such dues and charges, as the Board of Directors may prescribe. A manufacturer's representative shall not qualify as a Supplier Member nor shall a qualifying Supplier Member as described above, authorize any of their manufacturer's representative to attend GFA meetings in their place."

Products Supplied to Gasket Fabricators:

1._______________________ 2.____________________ 3. _____________________

Name:_____________________________ Title:____________________________

Company:___________________________________________________________

Address:____________________________________________________________

City:____________________________ State:__________ Zip:____________

Telephone:______________________________ Fax: _________________________

E-Mail:______________________________ Web Site Address: _____________________

Signature:______________________________ Date: ________________________



Please remit a print-out of this frame and payment to:

Gasket Fabricators Association
994 Old Eagle School Road
Suite #1019
Wayne, PA 19087