Membership Application

To apply for membership, fill out the form below and submit it, or click here to download a printable application that you can mail in.

Organization:

Representative Name:

First:

Middle:

Last:

Suffix:

Job Title:

Mailing Address:

City:

State:

Zip:

Country:

Phone:

( ) ext.

Cell Phone:

( )

Fax:

( )

E-mail:

* Required field

Website:

AMTA Membership is based on an annual membership from January 1 – December 31 each year.

Membership Classification: Please select the appropriate membership category. You and your organization will appear in the Annual Directory based on the membership category you select. Please see the enclosed "Membership Classifications" sheet for detailed definitions.

DIVISION I – Public Agencies, Industrial Users, and Water Suppliers

Large (50 employees or more) – includes 1 Primary Member (list above) & 3 Affiliate Members(3C) – please list 3 additional members names and titles:

1.	First:
	Middle:
	Last:
	Suffix:
	Job Title:

2.	First:
	Middle:
	Last:
	Suffix:
	Job Title:

3.	First:
	Middle:
	Last:
	Suffix:
	Job Title:

$675

Small (Fewer than 50 employees) – includes 1 Primary Member (list above) & 1 Affiliate Members(3C) – please list 1 additional member name and title:

1.	First:
	Middle:
	Last:
	Suffix:
	Job Title:

$350

DIVISION II – Manufacturers, Suppliers, Consultants, Engineers, and Architects

Large Firms (25 employees or more) – includes 1 Primary Member (list above) & 3 Affiliate Members(3D) – please list 3 additional members names and titles:

1.	First:
	Middle:
	Last:
	Suffix:
	Job Title:

2.	First:
	Middle:
	Last:
	Suffix:
	Job Title:

3.	First:
	Middle:
	Last:
	Suffix:
	Job Title:

$675

Small Firms (Fewer than 25 employees) – includes 1 Primary Member (list above) & 1 Affiliate Members(3D) – please list 1 additional member name and title:

1.	First:
	Middle:
	Last:
	Suffix:
	Job Title:

$350

DIVISION III – Associates
	A. Individuals & University/College Professors	$200
	B. Libraries and Students	$50
	C. Affiliates (with paid Division I member)	$125
	Identify primary representative of paid Division I organization membership:
	D. Affiliates (with paid Division II member)	$125
	Identify primary representative of paid Division II organization membership:

Member Profile Data

A. My organization can best be categorized as the following:
Consulting Firm
Engineering Firm
Municipality/Public
Manufacturer
Private Agency
Other

B. Brief description of your organization:

C. Years in Existence?

D. Reason for joining AMTA?

E. AMTA Services/Programs of interest:
Federal Legislative/Regulatory Activities
State Legislative/Regulatory Activities
Conferences/Workshops
Publications and Reports
Public Relations and Education
Networking/Affiliation opportunities
Other:

F. AMTA Committees of Interest:
Audit
Awards
Bylaws
Concentrate Disposal/Regulations
Finance
Government Programs
International Liaison
Membership
Nominating & Elections
Program
Public Outreach
Publications & Communications
Regional Affiliations
Technology Transfer

G. Other Association Memberships:
American Water Works Association
International Desalination Association
South Central Membrane Association
Southeast Desalting Association
WateReuse Association
Others:

H. Representative’s years of professional experience:

I. Representative’s Education Level/Licenses:
High School diploma
Associate's
Bachelor's
Master's
Doctoral
Post-Doctoral
Other:
Licenses:

J. How did you find out about AMTA?
Conference / Workshop
AMTA Publication
Another member
AMTA or other Website
Other publication
Newspaper
Brochure mailing
Other:

I am planning on paying by:

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