Calendar

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:
New Member Name:

Salutation:

First:
Middle:
Last:
Suffix:
Job Title:
Mailing Address:  
City:    State/Provence:    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.
However, if application is received after Oct. 1, membership benefits shall extend to the end of the following 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 to End User
A.

Large (300K+ population served) – 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:
Email:
2.
First:
Middle:
Last:
Suffix:
Job Title:
Email:

3.

First:
Middle:
Last:
Suffix:
Job Title:
Email:

 

 $675
B.

Medium (10K-300K population served) – includes 1 Primary Member (list above) & 3 Affiliate Members(3C) – please list 2 additional members names and titles:

1.
First:
Middle:
Last:
Suffix:
Job Title:
Email:
2.
First:
Middle:
Last:
Suffix:
Job Title:
Email:

 

 $475
C.

Small (<10K population served) – 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:
Email:
$350
DIVISION II – Company/Corporate Membership (Manufacturers, Suppliers, Consultants, Engineers, and Architects)
A.

Up to 15 Members – includes 1 Primary Member (list above) & 14 Affiliate Members(3D) – please list 14 additional members names and titles:

1.
First:
Middle:
Last:
Suffix:
Job Title:
Email:
2.
First:
Middle:
Last:
Suffix:
Job Title:
Email:

3.

First:
Middle:
Last:
Suffix:
Job Title:
Email:

4.

First:
Middle:
Last:
Suffix:
Job Title:
Email:

5.

First:
Middle:
Last:
Suffix:
Job Title:
Email:

6.

First:
Middle:
Last:
Suffix:
Job Title:
Email:

7.

First:
Middle:
Last:
Suffix:
Job Title:
Email:

8.

First:
Middle:
Last:
Suffix:
Job Title:
Email:

9.

First:
Middle:
Last:
Suffix:
Job Title:
Email:

10.

First:
Middle:
Last:
Suffix:
Job Title:
Email:

11.

First:
Middle:
Last:
Suffix:
Job Title:
Email:

12.

First:
Middle:
Last:
Suffix:
Job Title:
Email:

13.

First:
Middle:
Last:
Suffix:
Job Title:
Email:

14.

First:
Middle:
Last:
Suffix:
Job Title:
Email:

$2500
B.

Up to 10 Members – includes 1 Primary Member (list above) & 9 Affiliate Members(3D) – please list 9 additional members names and titles:

1.
First:
Middle:
Last:
Suffix:
Job Title:
Email:
2.
First:
Middle:
Last:
Suffix:
Job Title:
Email:

3.

First:
Middle:
Last:
Suffix:
Job Title:
Email:

4.

First:
Middle:
Last:
Suffix:
Job Title:
Email:

5.

First:
Middle:
Last:
Suffix:
Job Title:
Email:

6.

First:
Middle:
Last:
Suffix:
Job Title:
Email:

7.

First:
Middle:
Last:
Suffix:
Job Title:
Email:

8.

First:
Middle:
Last:
Suffix:
Job Title:
Email:

9.

First:
Middle:
Last:
Suffix:
Job Title:
Email:
$1750
C.

Up to 5 Members – includes 1 Primary Member (list above) & 4 Affiliate Members(3D) – please list 4 additional members names and titles:

1.
First:
Middle:
Last:
Suffix:
Job Title:
Email:
2.
First:
Middle:
Last:
Suffix:
Job Title:
Email:

3.

First:
Middle:
Last:
Suffix:
Job Title:
Email:

4.

First:
Middle:
Last:
Suffix:
Job Title:
Email:
$750
D.

Up to 2 Members – 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:
Email:

 

 $350
DIVISION III – Associates
A. Individuals & University/College Professors
$200
B. Libraries and Students
$50
C. Affiliates (with paid Division I member)
$125
D. Affiliates (with paid Division II member)
$200

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
Finance
International Liaison
Legislative/Regulatory Programs
Membership
Nominating & Elections
Program
Public Outreach
Publications & Communications
Regional Affiliations - South Central
Regional Affiliations - South East
Regional Affiliations - South West
Regional Affiliations - North Central
Regional Affiliations - North East
Regional Affiliations - North West
Technology Transfer

G. Other Association Memberships:
American Water Works Association
International Desalination Association
South Central Membrane Association
Southeast Desalting Association
Southwest Membrane Operator 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 intrested in running for position on AMTA Board
I am interested in presenting at a Technology Transfer Workshop or Confrence

I am planning on paying by:

Check Credit Card Invoice