AAPT Membership Application


THE ASSOCIATION OF ASPHALT PAVING TECHNOLOGISTS
Office of the Secretary-Treasurer
6776 Lake Drive Suite 215
Lino Lakes, MN 55014

651-293-9188 Fax 651-293-9193 email: aaptinfo@gmail.com or aapt@aapt.comcastbiz.net

APPLICATION FOR MEMBERSHIP AS
Member
Associate Member
Student Member (Must be current student)

I do hereby apply for membeship in the Association of Asphalt Paving Technologists and submit the following statement of my qualifications:
FULL NAME:
BIRTH DATE:
BUSINESS AFFILIATION:
FULL MAILING ADDRESS (street address, city, state, zip code, county):
TELEPHONE/FAX:
EMAIL ADDRESS:
UPLOAD RESUME (required only for Member applications):
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):
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.”

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:


Do not send payment now, you will be sent an invoice after you are accepted into membership.