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                                                                        Elastomer Products Group
                                                   2009 Membership Application & Sales Assessment



The Rubber Manufacturers Association's Elastomer Products Group, as authorized by its by-laws, requires
every member and/or applicant-member company to annually report Total Net Sales value of its
rubber/thermoplastic elastomer products in order to provide an equitable assessment of annual dues.
The conditions governing full membership are stated in the current RMA by-laws as follows:
   Any person, firm, corporation or other entity engaged in the manufacture of tires or non-tire finished
   rubber products in the United States may become a Manufacturer Member of the Association. Each
   Manufacturer Member shall be represented either by the person who is the Member or by an officer,
   employee or agent of the Member corporation, firm, or entity. Each person representing a Manufacturer
   Member of the Association shall be registered as a Member Representative in the manner prescribed
   by the Board of Directors of the Association. Upon all questions, each Manufacturer Member of the
   Association shall be entitled to one vote at each meeting of the Members.
We ask that all members (or applying members) supply all requested information, including an assessment
of annual sales and the applicable dues.
We expect all members to report a fair and equitable number that reflects the value of their sales of
elastomeric products, minus the purchase costs of the non-elastomeric components (e.g., fabric, metal,
reinforcement, inserts, fittings and connectors).
The confidentiality of all submitted information will be strictly maintained.
Before completing this form please carefully review the following instructions and guidelines.
Your completed application (pages 3 & 4) should be notarized and returned to the attention of:
Rubber Manufacturers Association
attn: Desoree Miner
1400 K Street, N.W. Suite 900
Washington, D.C. 20005
(202) 682-4856
INSTRUCTIONS FOR REPORTING OF SALES
TOTAL SALES to be reported should represent net realized sales revenue from rubber and thermoplastic
elastomer (TPE) goods (including goods produced for export). That is, gross sales to customers less trade
discounts, returns and all allowances, excise and sales taxes, transportation out, provisions for adjustment
losses, periodical volume rebates, price decline rebates, cash discounts on sales, allowances for factory
shipments to customers and royalties (assessed on sales basis). Sales from company-owned retail stores
should be reported at wholesale value. Sales of imported goods should be reported. Purchase costs of non-
elastomeric components can be deducted.
Sales of rubber and TPE goods purchased from other RMA-member manufacturers should be included, but
sales of goods to other RMA-member manufacturers should be excluded. The internal sale of goods within
the reporting company should be excluded.
Applicants for full membership (manufacturer) in the RMA must have a manufacturing facility in the United
States, with production of a rubber and/or thermoplastic good during the requested sales year.




   1400 K Street, N.W., Suite 900; Washington, D.C. 20005; (202) 682-4800; www.rma.org
                                                                       Elastomer Products Group
                                                  2009 Membership Application & Sales Assessment
                                                                                       Page 2 of 4



EXAMPLES OF WHAT TO REPORT:
Flat Belt/Sheet Rubber: Include net sales of all rubber and TPE products sold in the U.S. market including
imported goods and goods produced for export. Report sales of conveyor belts, sheet rubber, stair treads,
mats and matting, etc.
Hose: Include net sales of all rubber and TPE products sold in the U.S. market including imported goods and
goods produced for export. Exclude the purchase cost of continuous fiber reinforcement, fittings & connectors.
Molded & Extruded: Include net sales of all rubber and TPE products sold in the U.S. market including
imported goods and goods produced for export. Report sales of molded, extruded, lathe-cut, hard, and cellular
rubber/thermoplastic mechanical products, such as original equipment and replacement parts sold for use in
various industries including: aircraft, appliance, transportation (automotive, marine and rail), construction,
industrial machinery, electrical, ordinance, oil field, automatic dispensers, materials handling equipment, etc.
Power Transmission Belts: Include net sales of all rubber and TPE products sold in the U.S. market
including imported goods and goods produced for export. Exclude the purchase cost of continuous fiber
reinforcement & tensioners.
Roll Coverings: Include net sales of all rubber and TPE products sold in the U.S. market including imported
goods and goods produced for export. Report sales of roll coverings, rolls, covered rolls, and printer's
blankets, etc., excluding any metal components.
Roofing: Include net sales of all products sold in the U.S. market including imported goods and goods
produced for export. Report sales of reinforced and non-reinforced rubber roofing membranes of EPDM,
CSM, Polychloroprene, Butyl, cross-linked CPE, Epichlorohydrin, and combinations thereof; excluding
flashings and waterproof linings.
Sealing Products: Include net sales of all rubber and TPE products sold in the U.S. market including
imported goods and goods produced for export. Report sales of all shaft oil seals and seals having the general
configuration known as an O-ring irrespective of the material from which they may be made. Exclude all metal
components.
Other Products: Include net sales of all rubber and TPE products sold in the U.S. market including imported
goods and goods produced for export, not specified elsewhere.




TOTAL U.S. SALES OF RUBBER/TPE PRODUCTS                                      $ _____________________


       Minus Purchase Costs of Non-Elastomeric Components                    $ _____________________


                                              TOTAL NET SALES                $ _____________________*
* Please check applicable dues range on page 3.



   1400 K Street, N.W., Suite 900; Washington, D.C. 20005; (202) 682-4800; www.rma.org
                                                                         Elastomer Products Group
                                                    2009 Membership Application & Sales Assessment
                                                                                         Page 3 of 4


1. CONTACT INFORMATION (please print):
Company Name:            _________________________________________________________________

CEO Name:                _________________________________________________________________

Official Contact & Title (if different than CEO):     _________________________________________

Street Address:          _________________________________________________________________

City/State/Zip:          _________________________________________________________________

Phone:            ___________________________         Fax:   ___________________________________

E-mail:           ___________________________         Corporate website:    ________________________

2. SALES REPORTING & DUES ASSESSMENT
O         We are reporting sales for the calendar year ending December 31, 2007.

O         We are reporting sales for our most recent completed fiscal year ending, __________________.

We are reporting Total Net U.S. Sales (as calculated on page 2) in the range of:

O         Less than $10 million                       Annual Dues: $3,000
O         $10 million to less than $15 million        Annual Dues: $4,000
O         $15 million to less than $20 million        Annual Dues: $5,000
O         $20 million to less than $30 million        Annual Dues: $7,500
O         $30 million to less than $50 million        Annual Dues: $10,000
O         $50 million to less than $100 million       Annual Dues: $15,000
O         $100 million to less than $150 million      Annual Dues: $25,000
O         $150 million to less than $250 million      Annual Dues: $35,000
O         $250 million and up                         Annual Dues: $45,000

Preferred billing period:         O     Annual        O      Quarterly

CEO Signature            _________________________________________________________________
Subscribed and sworn to before me:

Notary Public Signature           ________________________          Date    ________________________

Mail pages 3 & 4 to Rubber Manufacturers Association; attn: Desoree Miner; 1400 K Street, N.W., Suite
900; Washington, D.C. 20005. Please do not include payment, as you will be billed as requested.


    1400 K Street, N.W., Suite 900; Washington, D.C. 20005; (202) 682-4800; www.rma.org
                                                                  Elastomer Products Group
                                             2009 Membership Application & Sales Assessment
                                                                                  Page 4 of 4


3. ADDITIONAL COMPANY INFORMATION (optional) - please print
Plant Name (1):     _________________________________________________________________

Address:            _________________________________________________________________

Plant Manager:      _______________________            Phone/e-mail: _______________________

Plant Name (2):     _________________________________________________________________

Address:            _________________________________________________________________

Plant Manager:      _______________________            Phone/e-mail: _______________________

Plant Name (3):     _________________________________________________________________

Address:            _________________________________________________________________

Plant Manager:      _______________________            Phone/e-mail: _______________________

Plant Name (4):     _________________________________________________________________

Address:            _________________________________________________________________

Plant Manager:      _______________________            Phone/e-mail: _______________________



HR Contact:   ______________________ Phone: _____________            e-mail: _________________

ESH Contact: ______________________ Phone: _____________             e-mail: _________________

Eng. Contact: ______________________ Phone: _____________            e-mail: _________________

Sales Contact:______________________ Phone: _____________            e-mail: _________________



Mail pages 3 & 4 to Rubber Manufacturers Association; attn: Desoree Miner; 1400 K Street, N.W., Suite
900; Washington, D.C. 20005. Please do not include payment, as you will be billed as requested.




FOR OFFICE USE ONLY
Sponsoring RMA members: ___________________________________________________________
                           ___________________________________________________________




   1400 K Street, N.W., Suite 900; Washington, D.C. 20005; (202) 682-4800; www.rma.org