AAPT
AAPT Membership Application

THE ASSOCIATION OF ASPHALT PAVING TECHNOLOGISTS
Office of the Secretary-Treasurer
4711 Clark Ave Suite G
White Bear Lake, MN 55110

651-293-9188; Fax 651-293-9193; e-mail: aapt@qwest.net

APPLICATION FOR MEMBERSHIP AS

Active Member __________
Junior Member __________

I, ___________________________ do hereby apply for membership in the Association of Asphalt Paving Technologists and submit the following statement of my qualifications:

FULL NAME:

BIRTH DATE:

BUSINESS AFFILIATION:

MAILING ADDRESS:

TELEPHONE/FAX:

EMAIL ADDRESS:

PRESENT (JOB) TITLE:

EDUCATION - TRAINING (colleges or universities, with nature of studies, degrees received, or practical experience, and dates):



PROFESSIONAL AND TECHNICAL SOCIETIES OF WHICH APPLICANT IS A MEMBER (include professional registrations):



TECHNICAL CONTRIBUTIONS (books, papers, inventions, and other technical contributions):



SPONSORS (names of at least one,* but preferably two or more, present members of the Association familiar with your qualifications for membership):



*It is preferable that not more than one of the sponsors have the same business affiliation as the applicant.

(For reproduction purposes, use of a typewriter for filling out this application is preferable. Otherwise, application should be printed with black ink or indelible pencil. Be sure to sign and date this application in the appropriate space on the bottom side.

PROFESSIONAL EXPERIENCE IN ASPHALT PAVING AND/OR RELATED TECHNOLOGY
 (list present position first)

DATES (year & month)
 From/To
TITLE OF POSITION, NAME OF EMPLOYER AND CHARACTER OF EMPLOYMENT
RESPONSIBLE POSITION*
(years or months)
NAME AND TITLE OF SUPERVISOR
 

 

 

 

  

 

 

 

  

 

 

 

 

 

 

 

 

 

 

 

  

 

 

 

  

 

 

 

 

 

 

 

 

 

 

 

  

 

 

 

  

 

 

 

 

 

 

 


* A "Responsible Position" implies definite responsibility for technical work in the asphalt field. The information given under "Character of Employment" should provide details substantiating the information on "Responsible Position." Further information may be offered in the space immediately below or on additional sheets.

I hereby declare that, if elected to membership, I will abide by the Constitution and By-Laws of the organization, and cooperate in its activities:


Signature of Applicant:

Date:

Action of Board of Directors:

Date: