POTENTIAL MEMBER QUESTIONNAIRE

Submitted by admin on March 9, 2010

The Personal Care Products Council
1101 17th Street, N.W., Washington, D.C. 20036
Phone: 202/331-1770, Fax: 202/331-1969

So that the Personal Care Products Council might better understand your company's relation to the industry, please complete and return this questionnaire to the Member Relations Department. Please submit by email or print out to mail or fax to the Council offices.

Note: Mail this form with dues form and payment to join right away. See Dues Information for form.

* - Required fields are marked with an asterisk.

1. Name and address of company applying for membership
2. Company's contact number
3. Contact information of individual completing questionnaire
4. Official Representative

If no, please identify who should be designated as the O.R.

5. Company name and address of the parent company

If company listed in question "1" is not the parent company, please list the name of the company and address of the parent company

6. Membership

The Council has two types of membership: Active and Associate. Please read the descriptions and select either "ACTIVE MEMBER COMPANIES" or "ASSOCIATE MEMBER COMPANIES" and mark the appropriate product categories/company type.

ACTIVE MEMBER COMPANIES
- manufacture and/or distribute finished cosmetic, personal care, fragrance or toiletry products for retail and/or salon use.
ASSOCIATE MEMBER COMPANIES
- supply goods and/or services to active member companies. Examples of goods and/or services are: chemical suppliers, fragrance suppliers, packaging companies, research laboratories, advertising agencies, magazines that contain cosmetic advertising, law firms, accounting firms, consultants, and executive search firms.

If you select other please specify

7. Your 2010 Council Dues

Your 2010 Council Dues are based on 2009 U.S. sales of personal care products (active members) or sales to the industry (associate members). Please enter your 2009 U.S. sales within this industry sector so that your dues can be calculated.

Thank you for completing the questionnaire. We'll be in contact shortly with pertinent membership information.
The Personal Care Products Council Member Relations Department.