Association of
Desk and Derrick
Clubs
2020 Membership Application

The Association of Desk and Derrick Clubs (ADDC), an international non-profit organization, is a premier provider of energy education and professional development. ADDC's purpose shall be to promote the education and professional development of individuals employed in or affiliated with the petroleum, energy and allied industries, and to educate the general public about these industries as well as the companies and global communities the members serve.

Last Name

Preferred Mailing Address	  Office	  Home

First Name	MI	Member Number	Region

Gender      M     F

Birthday (mm/dd)

Club

Company Name	Membership Type: Member

Job Title	Home Address

Company Address

City

State

City

State

Country

ZIP

Country	ZIP	Home Phone

Office Phone	Cell Phone (opt)

Primary Email

Age	  21-30	  31-40

  41-50

  51-60

Secondary Email   61-70	

71-80

  80+

How did you learn about us?

NOTE: Membership Dues and Donations to the Association of Desk and Derrick Clubs are not tax deductible as CHARITABLE CONTRIBUTIONS but may qualify as BUSINESS DEDUCTIONS on Federal and State Tax Returns. DUES WILL NOT BE USED FOR LOBBYING PURPOSES.

Release Name:  For purposes of membership recruiting, I authorize the Association of Desk and Derrick Clubs to release my name as part of a list of ADDC members.
Release Name?	  Yes	  No

Corporate Contribution

Amount

  Local

  Regional

  Association

Dues	Amount
Please complete and return this form, with check payable to:

(ADDC ($55.00) + Club Dues)

Signed	Date

Association Distribution Office
5014 FM 1500  Paris, TX 75460
Email: ado@addc.org Phone: 405-543-3464