NPA Membership Form

Membership Application

Please complete the form and submit it for review.

SECTION 1: APPLICANT INFORMATION

Applying Organization (or Individual) Name:

Business Address:

City, State, Zip:

Phone:

Website:

PRIMARY POINT OF CONTACT

Designated Primary POC Name/Title:

Address (if different from above:

City, State, Zip:

Phone:

Email:

ALTERNATE POINT OF CONTACT

Designated Alternate POC Name/Title:

Address (if different from above:

City, State, Zip:

Phone:

Email:

SECTION 2: MEMBERSHIP CLASSES & DUES

Please read the following membership category descriptions to determine on which best describes your NP involvment.

INDUSTRY MEMBERS

REGULAR MEMBERS: Natural Pozzolan (NP) production and sales in excess of 10,000 tons/year. Regular members have voting rights in the association. One vote per manufacturer or producer. ($5,000/year)

ASSOCIATE MEMBERS: Prospective producers of NP (or current producers with less than 10,000 tons/year production and sales of NP); Marketers or brokers of NP, Suppliers of equipment, materials, or services to the NP industry, and others in a related capacity. ($1,500/year)

AFFILIATE MEMBERS: Affiliate members are organizations or individuals with the same goals as the Association, but are not eligible for membership as a Regular or Associate Member. Examples of Affiliate Members are engineering firms, environmental firms, law firms, end-users of NPs (i.e. ready-mix producers, highway pavers, cement and wallboard producers, block producers, precast producers, cementitious materials containing NP, etc.), universities, agricultural interests, and organizations or individuals that promote the use of NPs in green building and sustainable development, and general NP enthusiasts. ($500/$300 year depending on size–see below)

SELECT CLASS

Membership dues are calculated on a full year's membership. Check the membership dues box related to the appropriate membership category as outlined above.

REGULAR MEMBER:
Production and sales in excess of 10,000 TPA - $5,000
ASSOCIATE MEMBER:
Prospective Producer or Producer under 10,000 TPA - $1,500
Supplier - $1,500
Marketer - $1,500
AFFILIATE MEMBER:
Large - 10 or more full time/contract employees: $500
Small - Up to 10 full time/contract employees: $300

SECTION 3: NP RELATED INTEREST AND/OR INVOLVEMENT

Provide a descriptive profile of applicant's NP related business interests and activities. THIS SECTION MUST BE COMPLETED TO PROCESS THE APPLICATION.

SECTION 4: NP COMMITTEE INVOLVEMENT

Check one or more boxes to indicate your interest in serving on any of the following NPA program committees.

Membership/Events Committee
Government Affairs Committee
Sustainability/Green Initiatives/LEEDS Committee
Specifications/Standards
R&D/Testing Committee

SECTION 5: CERTIFICATION

Name/Title of Designated Representative Submitting this Application:

Date of Application Submission:

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SECTION 6: PAYMENT

Please use the PAY DUES button below to submit payment (via CC) for your membership dues. Select the appropriate membership class from the dropdown menu before clicking button. You may also submit payment with a check to: Natural Pozzolan Association, 100 East 155 South, Malad City, ID 83252.

NATURAL POZZOLAN ASSOCIATION

100 East 155 South, Malad City, ID 83252 • 208.252.2808 • info@pozzolan.org

IMPROVING CONCRETE DURABILITY

NPA Membership Form

Membership Application

SECTION 1: APPLICANT INFORMATION

SECTION 2: MEMBERSHIP CLASSES & DUES

SECTION 3: NP RELATED INTEREST AND/OR INVOLVEMENT

SECTION 4: NP COMMITTEE INVOLVEMENT

SECTION 5: CERTIFICATION

SECTION 6: PAYMENT

Thank You! Your application has been submitted. Please SUBMIT PAYMENT above.

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