Apply for Membership

To apply and pay online, complete the application form below. If you wish to apply and pay by check, please complete and mail the print form with your check.

Membership Type
Revised October 10, 2018

Producer — $2,000 annually
Companies that manufacture, react, let‐down or otherwise produce or sell modified asphalt products.

Supplier — $2,000 annually
Companies that sell polymers, additives or any product considered to enhance the properties and performance of asphalt.

Associate — $850 annually
Qualified companies provide services, software, plant and lab equipment and other indirect materials to the asphalt industry. This category also includes firms that provide testing, formulation design, engineering and research. It also includes contractors and consultants.

Affiliated International — $1,000 annually
For Producers and Suppliers who do not do business in North America (United States, Canada and Mexico).

Affiliated Associations — No Charge
Nonprofit state and national trade associations and academic institutions serving the interests and advancement of the asphalt Industry.

Friends of AMAP — $85 annually
Students, industry retirees, and others who have a noncommercial interest in AMAP’s mission.

Membership applications are subject to approval by the AMAP Board of Directors. Please direct any questions to AMAP’s Executive Director at 330-714-4117.
Please select membership type*
Applicant Information
Primary Representative*
First Last
Company*
Title*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Office Phone*
Cell Phone
Fax
Email*
Enter Email Confirm Email
Show this person as a contact for your company’s listing on AMAP’s website?
- Yes
- No
Additional Representatives
Please list any additional representatives of your company. Click the (+) icon to add more contacts.
First Name Last Name Title Best Phone Email List online as contact?
Company Information
For the Public Listing of AMAP Members (modifiedasphalt.org/membership/current-members)
Company Mailing Address (if different from Primary Contact's address)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Main Phone*
Main Fax
Website
Company description. Please describe your company’s business activity in a short paragraph
Products and Services. Please list the products and services provided by your company.
Please limit your response to ten items. Click the (+) icon to add more lines.
Markets Served
– Producers, please list the states where you produce state specification products.
– Materials and service providers, please list the geographic areas you serve (individual states, U.S., North America, global, etc.)
Billing Contact
Select if the billing contact is the same as applicant.
- Yes
Billing Contact*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
International Applicants*
Note to AMAP members outside of the United States: To renew your membership by credit card, please enter the code provided to you by AMAP. Contact Jim Sattler at jimsattler@modifiedasphalt.org if you require a code.
Phone*
Fax
Email*
Enter Email Confirm Email
Payment
Note to AMAP members outside of the United States: To enter a credit card, first please enter the code provided to you by AMAP in the Submitter Information section above. Contact Jim Sattler at jimsattler@modifiedasphalt.org if you require a code.
Payment
Total
$0.00
Credit Card

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
After you click "Submit", you will receive a confirmation email. This also serve as your receipt.

Apply for Membership

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Applicant Information

Additional Representatives

Company Information

Billing Contact

Payment

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First Name	Last Name	Title	Best Phone	Email	List online as contact?

Apply for Membership

Membership Type

Applicant Information

Additional Representatives

Company Information

Billing Contact

Payment

Payment

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