2018-2019 Producer Membership Application



EPAC’s membership year begins October 1, 2018 and ends September 30, 2019.Please Complete And Return This Form With Your Cheque In Canadian Funds To:The Explorers and Producers Association of CanadaEPAC GST #12337 95961060, 717 – 7 Avenue SWCalgary, AB T2P 0Z3Company:_____________________________________________________________________________Contact Name:_____________________________________________________________________________Title:_____________________________________________________________________________CEO’s Name (if different from principal contact): ______________________________________________________Mailing Address:_____________________________________________________________________________ _______________________________________________ Postal Code: __________________Business Phone: (________) _________________________ Direct: (________) __________________________Email: _____________________________________________________________________________ Company Website: _____________________________________________________________________________Your Company name will be listed on the EPAC Website as a member. Your personal contact information is not disclosed to the public. Membership in EPAC constitutes your consent to receive electronic messages from EPAC including our membership Newsletter, Advisories and other information for members. You may unsubscribe at any time from the Newsletter and still receive other membership information. Company Information (For internal EPAC use)1. Please insert average CDN daily production:Please allocate your production by category below:Oil & Liquids____________ bpdOil & Liquids _____% of Total ProductionNatural Gas____________ boepd (10mcf:1bbl) Natural Gas_____%Total____________ boepdOilsands_____% 2. Number of full time equivalent staff (employees and consultants): _______________ 3. Please indicate your areas of activity by % of total:Alberta_____British Columbia _____Saskatchewan_____ Manitoba _____USA _____ Other _____ 4. Is your company publicly traded or privately owned:Public ________ Private ________ 1. Capital Expenditures (Capex) for current fiscal year: $___________________________________________2. Capex allocation by region in current fiscal year:AB_____%BC_____%SK_____%Other_____%If Other, please specify region ____________________3. Estimated Capex for next fiscal year: $_____________________________________________________4. Estimated Capex allocation by region for next fiscal year?AB_____%BC_____%SK_____%Other_____% If Other, please specify region ____________________5. If estimated Capex allocation by region will likely change between fiscal years, what is the reason? ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________6. What are the most important issues you are facing in the upstream oil & gas sector in the following jurisdictions?Alberta: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________British Columbia: __________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________Saskatchewan:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Federal: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Other: ____________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________ ................
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