OAIMA Membership Application

Membership Type:

Please Choose:

Company Information

Company Name
Office Address
Suite/P.O. Box
City State Zip
Phone Fax
Website

Contact Information

First Name MI Last Name
Title
Email

Active Members Only - Additional Information

For Active Members, please complete the following additional information. You will be invoiced the remaining balance of your annual membership dues based on the number of plants and tonnage sold.
Plant Address
City State Zip
County
Phone Fax
Product Type(s)
Sand Stone Slag Salt Recycled
Product or Business Description
For the following, please provide number value only. Alphabetical and special characters are not accepted in these fields.
Tonnage Sold (Previous Year)
Number of Plants
Number of Yards
   - denotes required fields