"*" indicates required fields NameThis field is for validation purposes and should be left unchanged.Individual Membership: Shall consist of any person that provides goods, services, materials, etc., and any individual water &/or wastewater operator, manager, board member, council member associated with a current member system; the holder of individual membership shall be non-voting, is ineligible to hold position on the Board of Directors or as an Officer of the Association. The individual shall also be associated with a member system to have an individual membership.New or Renewing Member:* New Member Renewing Member AFFILIATED SYSTEM NAME*(Required Membership)Your Name* First Last Organization / Company NameMailing Address* Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone*FaxEmail* Enter Email Confirm Email Individual Membership Price: Other InformationPlease list additional names, addresses, telephone numbers and any other information you deem necessary to your membership.Donate to the Ernie Faucett Scholarship FundSelect...$25$50$100Other amountNo Thank YouOther amount* Total Due How do you wish to pay?* Pay online now Pay by invoice Payment Method*PayPal CheckoutCredit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name
