MEMBERSHIP
APPLICATION FORM
ROCKY MOUNTAIN ASPHALT USER/PRODUCER GROUP
We hereby apply for membership to the Rocky Mountain Asphalt User/Producer Group. The effective dates of membership are from October 1, 2008 to September 30, 2009. Payment of annual dues is required by October 1 of each fiscal year. Membership entitles the organization to one designated voting member and representative on each of the subcommittees.
__________
State or Province Highway or Transportation Department – includes up to
six
reimbursed meeting trips per year.
Cost $3500
__________ Oil Companies, Contractors, Consultants, Material Suppliers, Federal
Government Agencies and other Interested Parties.
Cost $500
__________ Local Government and Academia. Cost $50.00
Name
of Voting Member:___________________________________________________
Title:___________________________________________________________________
Organization:_____________________________________________________________
Address:________________________________________________________________
Phone:____________________
Fax:___________________ E-Mail:________________
SUBCOMMITTEES
(Optional)
(Please
include address/phone/fax/email if different than above):
Binder
Subcommittee Member Name:_________________________________________
Mixture
& Construction Subcommittee Member Name:___________________________
Payment
Enclosed_______ Check# ________ Date_________(Your canceled check is your receipt)
TO INSURE THE
ACCURACY OF OUR RECORDS, PLEASE INCLUDE THIS FORM WITH YOUR REMITTANCE:
RETURN TO: