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AWPCA GROUP MEMBERSHIP or RENEWAL
Use this form if you have more than one person renewing/joining AWPCA
Company/Municipality:
*
Address
*
Street Address
City
State / Province / Region
Postal / Zip Code
Business Telephone:
*
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-
####
Fax:
###
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Email:
*
AWPCA Dues:
Please select
40.00
80.00
120.00
160.00
200.00
240.00
280.00
320.00
360.00
400.00
440.00
480.00
520.00
560.00
600.00
Check appropriate box for the number of people you are paying for. MEMBERSHIP DUES in the amount of $40.00 are due on or before January 1st each year. Unpaid dues are in arrears February 15th of each year.
Name/Certification/Grade/Email:
Name/Certification/Grade/Email:
Name/Certification/Grade/Email:
Name/Certification/Grade/Email:
Name/Certification/Grade/Email:
Name/Certification/Grade/Email:
Name/Certification/Grade/Email:
Name/Certification/Grade/Email:
Name/Certification/Grade/Email:
Name/Certification/Grade/Email:
Name/Certification/Grade/Email:
Name/Certification/Grade/Email:
Name/Certification/Grade/Email:
Name/Certification/Grade/Email:
Name/Certification/Grade/Email:
Please follow this example when filling in the boxes above(John Doe/Water or Wastewater or Dual/IV/jdoe@water.org)
