Application for Participation

This application for services is participation in the Flood Mitigation Certification Program managed by the Association of State Floodplain Managers, along with its partners FM Approvals, and the US Army Corps of Engineers. Testing (separate agreement and fee) will be scheduled upon receipt of application fee by the ASFPM

Date *

Manufacturer Information

(List all locations)

Manufacturer Name *

Location Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Email *

Phone

Manufacturer Technical Contact Information

Technical POC (TPOC)

TPOC Address (if different)

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

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TPOC Email

TPOC Phone

Testing/Certification Requested

Total Amount

$0.00

Send check by mail:
ASFPM
8301 Excelsior Drive
Madison, WI 53717

Consent to Share Certification & Testing Information

By entering into the testing and certification program, the manufacturer consents to share all submitted documentation and test results with FM Approvals, the ASFPM, and the US Army Corps of Engineers. It is understood and agreed to by the manufacturer that the results of all water related tests will be contained within a database maintained by the ASFPM and routinely posted on the program’s web site, floodmitigationcertification.org.

Please sign below to indicate that this consent is understood.

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