KPMA Marketer Membership Application Jobber membership dues are assessed on a volume (combined gasoline and diesel sales in Kentucky for the previous 12 months) basis, in gallons/year. Please see below for dues amounts, and select which reflects your company's records for the year:*Less than 1.5 million - $5351.5 - 2.5 million - $6252.5 -3.5 million - $9353.5 - 4.5 million - $1,2454.5 - 5.5 million - $1,5605.5 - 6.5 million - $1,8706.5 - 7.5 million - $2,1807.5 - 10 million - $2,49510 - 15 million - $2,67515 - 20 million - $2,97020 - 25 million - $3,26525 - 30 million - $3,56530 - 40 million - $3,86040 - 50 million - $4,16050 - 60 million - $4,45560 - 70 million - $4,75070 - 80 million - $5,05080 - 90 million - $5,34590 - 100 million - $5,645More than 100 million - $5,940Membership dues are prorated to the calendar month in which you join. Complete this form and mail a check for dues to Kentucky Petroleum Marketers Association, 2365 Harrodsburg Road, Suite A325, Lexington, KY 40504, or we will invoice you for the amount of your membership upon the receipt of this form. Name* First Last Company*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Is this address also your billing address?*YesNoBilling Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Office Phone*Email* Enter Email Confirm Email Website After submission of this form, KPMA will email you a copy of your invoice. Questions? Contact KPMA at 859.219.3571 or email kpma@kpma.orgPhoneThis field is for validation purposes and should be left unchanged.