Thank you for supplying the information below for the AMAP Member Information Guide. This online guide provides unparalleled exposure for AMAP members to potential customers worldwide.If you have any technical difficulties, please contact Brian Hirt, firstname.lastname@example.org, 402-770-9067.If you have any questions about your membership, please contact Jim Sattler, email@example.com, 330-714-4117.Your Contact InformationInformation in this section will not be published in the Member Information Guide. We are collecting it in case we need to contact you with questions about your submission.You may enter technical and sales/marketing contacts (including yourself, if appropriate) for your listing in the "Company Contacts" section toward the end of this form.Name* First Last Company*Phone*Email* Your Company's Primary BusinessPlease select all that apply.* Asphalt: Producer/Modifier/Supplier Polymer: Producer/Supplier Additive (Non-Polymer): Producer/Supplier Process Equipment: Producer/Supplier Lab Equipment: Producer/Supplier Lab and Consulting Services Products and Services OfferedAsphaltPlease select all asphalt products that your company produces, modifies or supplies. Polymer Modified Asphalt Hot Mix Asphalt Warm Mix Asphalt Cold Mix Asphalt Roofing Asphalt Emulsified Asphalt Crack Sealants Slurry Seals Cutbacks Chip Seals Tack Coats Microsurfacing Ground Tire Rubber Binders Other Please list other Asphalt products not shown above.*PolymersPlease select all polymer modifiers that your company produces or supplies. (Do NOT mark these if your company only sells modifiers in mix or asphalt cement; in that case, mark the "Asphalt" category above instead.) Styrene-butadiene-styrene (SBS) Styrene-ethylene-butadiene-styrene (SEBS) Styrene-isoprene-styrene (SIS) Styrene-butadiene Rubber (SBR) Latex Natural Latex Nitrile Rubber (NBR) Butadiene Rubber (BR) Ethylene-vinyl-acetate (EVA) Terpolymers Ground Tire Rubber (GTR) Other Please list other Polymers not shown above.*Additives (Non-Polymers)Please select all non-polymer modifiers that your company produces or suppies. (Do NOT mark these if your company only sells modifiers in mix or asphalt cement; in that case, mark the "Asphalt" category above instead.) Cross Linking Agents Surfactants Reoderants Waxes Gilsonite Polyphosphoric Acid (PPA) Rejuventators Other Please list other Additives (Non-Polymers) not shown above.*Process EquipmentPlease select all that your company produces or supplies. Plant Heaters High Shear Mills Tanks Emulsion Tanks Other Please list other Process Equipment not shown above.*Lab EquipmentPlease select all that your company produces or supplies. Dynamic Shear Rheometers Mixers Viscometers Rolling Thin-Film Ovens Bending Beam Rheometers Softening Point Apparatus Ovens Ashing Ovens Ductilometers Penetrometers Ultraviolet Microscopes Other Please list other Lab Equipment not shown above.*Lab and Consulting ServicesPlease select all that your company performs. Mix Design PMA Plant Design Product Development Environmental ISO Certification AASHTO Accreditation Quality Plan Program Pavement Preservation New Business Development Instrumentation Other Please list other Lab or Consulting Services not shown above.*Geographic Markets ServedPlease indicate the geographic regions your company serves.*Entire GlobeSelect Global RegionsRegions Served* United States Canada Mexico Central America South America Western Europe Eastern Europe Asia Africa Oceania Part of United States Served*Entire United StatesSelect StatesStates Served* Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Part of Canada Served*Entire CanadaSelect ProvincesCanadian Provinces Served* Alberta British Columbia Manitoba New Brunswick Newfoundland & Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Company ListingThe following information will be shown on your company's listing in the AMAP Member Information Guide.Company*Company LogoPlease provide a high resolution or vector logo you would like to use for your company's listing.Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Website Company DescriptionCompany ContactsThe following contacts will be included with your company listing. You may list a technical contact and up to four sales/marketing contacts to be included in your company's listing in the AMAP Member Information Guide.Technical ContactName First Last TitlePhoneEmail Sales/Marketing Contact(s)Name* First Last Title*Phone*Email* Territory and/or Product Responsibilities Check to add another Sales/Marketing Contact Name* First Last Title*Phone*Email* Territory and/or Product Responsibilities Check to add another Sales/Marketing Contact Name* First Last Title*Phone*Email* Territory and/or Product Responsibilities Check to add another Sales/Marketing Contact Name* First Last Title*Phone*Email* Territory and/or Product Responsibilities*Thank You!Please click the "Submit" button below to complete this form and sent your data to AMAP.