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                                                                  Elastomer Products Group
                                  2009 Membership Application & Sales Assessment -- Supplier




The Rubber Manufacturers Association's Elastomer Products Group, as authorized by its by-laws,
requires every member and/or applicant-member supplier company to annually report the amount
of their global sales to the rubber products manufacturing industry for the purpose of calculating an
equitable assessment of annual dues. Sales to be reported should represent net realized sales
revenue.
The conditions governing supplier membership are stated in the current RMA by-laws as follows:
  Any person, firm, corporation or other entity engaged in the United States in the manufacture
  or supply of materials used to make finished rubber products (including, but not limited to,
  chemical, elastomer, machinery and equipment, and other raw material producers) may
  become a Supplier Member of the Association. Each Supplier 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 Supplier 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 Supplier Member of the Association
  shall be entitled to one vote at each meeting of the Members. Supplier Members may serve
  as non-voting members of the Board of Directors at a ratio no greater than that represented
  by the dues of Supplier Members as a percentage of the overall Association budget. Supplier
  members shall have such other benefits, obligations and rights of participation in the affairs of
  the Association as shall be permitted by law and prescribed by the Board or by the Executive
  Committee to the extent authorized by the Board.
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 global
sales to the rubber products manufacturing industry. To facilitate your response, the RMA has kept
this reporting form simple. You are asked to report the extent of your sales to the industry by "tier",
and also to estimate the breakdown of company sales to tire manufacturers vs. non-tire (general and
industrial products) manufacturers.
The confidentiality of all submitted information will be strictly maintained.
Your completed application 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




   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 -- Supplier
                                                                                    Page 2 of 3



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, __________________.

Indicate which of the following tiers represents your company's annual global sales to the finished rubber
products manufacturing industry for the time period indicated above. Applicable dues levels are also provided.

O         $100 million or less                       Annual Dues: $3,450
O         Over $100 million, up to $200 million      Annual Dues: $5,750
O         Over $200 million                          Annual Dues: $11,500

We estimate that our percent of sales to the tire industry is __________ %.
We estimate that our percent of sales to the non-tire finished rubber products industry is __________ %.
Preferred billing period:        O     Annual        O      Quarterly


CEO Signature            _________________________________________________________________


Subscribed and sworn to before me:


Notary Public Signature          ________________________           Date    ________________________


Mail this form 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 -- Supplier
                                                                              Page 3 of 3


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 this form 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