Join NWMOA – Membership Application To apply for membership, fill out and submit the form below, or download a printable application form that you print, fill out and mail. MemberPlease refrain from using all caps/uppercase letters, please use sentence structure letter case.Salutation*Mr.Mrs.Ms.Dr.First Name*Middle InitialLast Name*SuffixJob Title* Organization & AddressOrganization*Mailing Address*City*State/ProvinceZIP/Postal CodeCountry* Contact InformationTelephone*Cell PhoneEmail Address* Website Billing Contact InformationEnter billing contact information, if applicableBilling Contact Name First Last Billing Contact Email Address Email address sent to billing contact, if applicableBilling Contact Telephone Please send copy of the invoice/receipt to Billing Contact Volunteer OpportunitiesCommittee Preferences Bylaws/Policies Legislative Operator Certification Membership Public Relations Newsletter Program/Technology Transfer Audit/Finance Awards/Scholarships Election Other Interests I am interested in running for a position on the NWMOA Board of Directors. I am interested in presenting at a Symposium, Workshop, or hosting an event at my facility. Company Description & Member BioCompany DescriptionMember Bio Membership LevelPublic Agencies, Industrial Users and Water Suppliers: 1A - membership includes 1 primary member & 5 additional 1B or 3A affiliate members Manufacturers, Suppliers, Consulting Firms: 2A - membership includes 1 primary member & 3 additional 3B affiliate members 2B - membership includes 1 primary member & 1 additional 3B affiliate memberMembership Type*1A - Public Agencies, Industrial Users and Water Suppliers, $3601B - Operator Individual Membership, $602A - Manufacturers, Suppliers, Consulting Firms, $4802B - Small Firms - Fewer than 5 employees, $2403A - Individual employed by a Public Agency who is not an Operator, $603B - Individuals affiliated with a paid Division 2 Member, $1203C - Other Interested Individuals (not affiliated with any organization, $1503D - Full-Time Student/Intern (must submit proof along with application), $25Total $0.00 Included Member 1Salutation - Included Member 1Mr.Mrs.Ms.Dr.First Name - Included Member 1Middle Initial - Included Member 1Last Name - Included Member 1Job Title - Included Member 1Email Address - Included Member 1 Member Bio - Included Member 1I would like to network with NWMOA Members, Operators, Attendees, Speakers, Moderators, Exhibitors, Sponsors or Board, please share my contact information (cell phone # will not be shared) - Included Member 1*YesNo Included Member 2Salutation- Included Member 2Mr.Mrs.Ms.Dr.First Name - Included Member 2Middle Initial - Included Member 2Last Name - Included Member 2Job Title - Included Member 2Email Address - Included Member 2 Member Bio - Included Member 2I would like to network with NWMOA Members, Operators, Attendees, Speakers, Moderators, Exhibitors, Sponsors or Board, please share my contact information (cell phone # will not be shared) - Included Member 2*YesNo Included Member 3Salutation - Included Member 3Mr.Mrs.Ms.Dr.First Name - Additional Member 3Middle Initial - Included Member 3Last Name - Included Member 3Job Title - Included Member 3Email Address - Included Member 3 Member Bio - Included Member 3I would like to network with NWMOA Members, Operators, Attendees, Speakers, Moderators, Exhibitors, Sponsors or Board, please share my contact information (cell phone # will not be shared) - Included Member 3*YesNo Included Member 4Salutation - Included Member 4Mr.Mrs.Ms.Dr.First Name - Included Member 4Middle Initial - Included Member 4Last Name - Included Member 4Job Title - Included Member 4Email Address - Included Member 4 Member Bio - Included Member 4I would like to network with NWMOA Members, Operators, Attendees, Speakers, Moderators, Exhibitors, Sponsors or Board, please share my contact information (cell phone # will not be shared) - Included Member 4*YesNo Included Member 5Salutation - Included Member 5Mr.Mrs.Ms.Dr.First Name - Included Member 5Middle Initial - Included Member 5Last Name - Included Member 5Job Title - Included Member 5Email Address - Included Member 5 Member Bio - Included Member 5I would like to network with NWMOA Members, Operators, Attendees, Speakers, Moderators, Exhibitors, Sponsors or Board, please share my contact information (cell phone # will not be shared) - Included Member 5*YesNo Division IB - Additional Members Price: $60.00 How many Additional Members will you include in this application? Count012345 Division IIB - Additional Members Price: $120.00 How many Additional Members will you include in this application? Count012345 Division IIIA - Additional Members Price: $60.00 How many Additional Members will you include in this application? Count012345 Division IIIB - Additional Members Price: $120.00 How many Additional Members will you include in this application? Count012345 Total $0.00 Additional Member 1Salutation - Additional Member 1MrMrsMsDrFirst Name - Additional Member 1Middle Initial - Additional Member 1Last Name - Additional Member 1Job Title - Additional Member 1Email Address - Additional Member 1 Member Bio - Additional Member 1I would like to network with NWMOA Members, Operators, Attendees, Speakers, Moderators, Exhibitors, Sponsors or Board, please share my contact information (cell phone # will not be shared) - Additional Member 1*YesNoAdditional Member 2Salutation - Additional Member 2MrMrsMsDrFirst Name - Additional Member 2Middle Initial - Additional Member 2Last Name - Additional Member 2Email Address - Additional Member 2 Job Title - Additional Member 2Member Bio - Additional Member 2I would like to network with NWMOA Members, Operators, Attendees, Speakers, Moderators, Exhibitors, Sponsors or Board, please share my contact information (cell phone # will not be shared) - Additional Member 2*YesNoAdditional Member 3Salutation - Additional Member 3MrMrsMsDrFirst Name - Additional Member 3Middle Initial - Additional Member 3Last Name - Additional Member 3Email Address - Additional Member 3 Job Title - Additional Member 3Member Bio - Additional Member 3I would like to network with NWMOA Members, Operators, Attendees, Speakers, Moderators, Exhibitors, Sponsors or Board, please share my contact information (cell phone # will not be shared) - Additional Member 3*YesNoAdditional Member 4Salutation - Additional Member 4MrMrsMsDrFirst Name - Additional Member 4Middle Initial - Additional Member 4Last Name - Additional Member 4Email Address - Additional Member 4 Job Title - Additional Member 4Member Bio - Additional Member 4I would like to network with NWMOA Members, Operators, Attendees, Speakers, Moderators, Exhibitors, Sponsors or Board, please share my contact information (cell phone # will not be shared) - Additional Member 4*YesNoAdditional Member 5Salutation - Additional Member 5MrMrsMsDrFirst Name - Additional Member 5Middle Initial - Additional Member 5Last Name - Additional Member 5Email Address - Additional Member 5 Job Title - Additional Member 5Member Bio - Additional Member 5I would like to network with NWMOA Members, Operators, Attendees, Speakers, Moderators, Exhibitors, Sponsors or Board, please share my contact information (cell phone # will not be shared) - Additional Member 5*YesNoAdditional IIIA Member 1Salutation - Additional IIIA Member 1MrMrsMsDrFirst Name - Additional IIIA Member 1Middle Initial - Additional IIIA Member 1Last Name - Additional IIIA Member 1Email Address - Additional IIIA Member 1Job Title - Additional IIIA Member 1Member Bio - Additional IIIA Member 1I would like to network with NWMOA Members, Operators, Attendees, Speakers, Moderators, Exhibitors, Sponsors or Board, please share my contact information (cell phone # will not be shared) - Additional IIIA Member 1*YesNoAdditional IIIA Member 2Salutation - Additional IIIA Member 2MrMrsMsDrFirst Name - Additional IIIA Member 2Middle Initial - Additional IIIA Member 2Last Name - Additional IIIA Member 2Email Address - Additional IIIA Member 2Job Title - Additional IIIA Member 2Member Bio - Additional IIIA Member 2I would like to network with NWMOA Members, Operators, Attendees, Speakers, Moderators, Exhibitors, Sponsors or Board, please share my contact information (cell phone # will not be shared) - Additional IIIA Member 2*YesNoAdditional IIIA Member 3Salutation - Additional IIIA Member 3MrMrsMsDrFirst Name - Additional IIIA Member 3Middle Initial - Additional IIIA Member 3Last Name - Additional IIIA Member 3Email Address - Additional IIIA Member 3Job Title - Additional IIIA Member 3Member Bio - Additional IIIA Member 3I would like to network with NWMOA Members, Operators, Attendees, Speakers, Moderators, Exhibitors, Sponsors or Board, please share my contact information (cell phone # will not be shared) - Additional IIIA Member 3*YesNoAdditional IIIA Member 4Salutation - Additional IIIA Member 4MrMrsMsDrFirst Name - Additional IIIA Member 4Middle Initial - Additional IIIA Member 4Last Name - Additional IIIA Member 4Email Address - Additional IIIA Member 4Job Title - Additional IIIA Member 4Member Bio - Additional IIIA Member 4I would like to network with NWMOA Members, Operators, Attendees, Speakers, Moderators, Exhibitors, Sponsors or Board, please share my contact information (cell phone # will not be shared) - Additional IIIA Member 4*YesNoAdditional IIIA Member 5Salutation - Additional IIIA Member 5MrMrsMsDrFirst Name - Additional IIIA Member 5Middle Initial - Additional IIIA Member 5Last Name - Additional IIIA Member 5Email Address - Additional IIIA Member 5Job Title - Additional IIIA Member 5Member Bio - Additional IIIA Member 5I would like to network with NWMOA Members, Operators, Attendees, Speakers, Moderators, Exhibitors, Sponsors or Board, please share my contact information (cell phone # will not be shared) - Additional IIIA Member 5*YesNo Payment InformationPayment Method*Credit Card - Online PaymentCredit Card - Use Card on FileCredit Card - Call MeeCheck (Bank Wire w/o processing fee) - Online PaymentCheckInvoiceIf paying by Check, make payable to Northwest Membrane Operator Association, and mail to 12592 West Explorer Dr., Ste. 200, Boise, ID 83713. 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