Association of Asphalt Paving Technologists

ASSOCIATION OF ASPHALT PAVING TECHNOLOGISTS

Annual Meeting and Technical Sessions March 13-16, 2016

The Westin Indianapolis, Indianapolis, IN

PRE-REGISTRATION INFORMATION

A separate registration form for each attendee should be completed and returned, with remittance, no later than March 6, 2016. Also, we offer online registration. Go to our website at www.asphalttechnology.org and go to the Annual Meeting Page. To register by FAX send this form to (651)293-9193.

REGISTRATION FEES INCLUDE A LINK TO PREPRINTS, A BANQUET TICKET (Tuesday) AND AN ICE BREAKER RECEPTION (Sunday). Additional banquet tickets may be purchased at $100 each. The Spouse Package is $260 – it includes the Sunday Ice Breaker Reception, Tuesday evening Banquet, Continental Breakfasts (Monday – Wednesday), and participation in tour packages.

Registration is being managed by the Asphalt Institute. Alternatively, checks should be made payable to the AAPT and mailed with this registration form to:

AAPT

6776 Lake Drive Suite 215

Lino Lakes MN 55014

If you have any questions, please contact the AAPT office at (651) 293-9188. FULL REFUNDS WILL ONLY BE MADE UP TO MARCH 6, 2016. Executive Director Michael Anderson must be notified by letter of request for refunds.

SPOUSE INFORMATION

Name ______Spouse Name ______

Company ______Spouse Address ______

Address______Spouse E-mail: ______

City/State/ZIP______

Phone: ______Fax ______E-mail: ______

Banquet Choice (Check One) Spouse Banquet Choice (Check One)

Beef Fish Beef Fish

______

Member pre-registration $475.00

Non-Member pre-registration $675.00

Member registration at meeting $575.00

Non-member registration at meeting $775.00

Spouse Package (includes banquet ticket) $260.00

Monday Night Event (optional)………………………………………...$40.00

Additional banquet tickets _____ at $100.00 each ……………… $______

STUDENT banquet tickets _____ at $25.00 each $______

2016 DUES (ONLY IF OUTSTANDING)……………………………………….. $200.00

AAPT Scholarship Donation $25.00 $50.00 $100.00Other______

TOTAL FEES $______

Method of Payment:

MasterCard Visa American Express Discover Check

Card Account Number ______Expiration Date ______Security Code:______

Cardholder’s Name ______Cardholder’s E-mail ______

Funds Transfer: US Bank, 7984 Lake Drive, Lino Lakes, MN 55014 USA Account #104782748263 (NEW)

Swift code: USBKUS44IMT Routing Number: 091000022

FOR OFFICE USE ONLY

Payment received by: Initials______Date______Amount ______Method of Payment ______