Northwest Membrane Operator Association

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You are here: Home / Join NWMOA – Membership Application

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.

Primary Member
Salutation*
First Name*
Middle Initial
Last Name*
Suffix
Job Title*
Organization & Address
Organization*
Mailing Address*
City*
State/Province
ZIP/Postal Code
Country*
Contact Information
Telephone*
Cell Phone
Email Address*
Website
Communication and Data Sharing Preference
NWMOA has been diligent in Data Security and being compliant with US and other Nations regulations in sharing your contact information as well as receiving email communications from NWMOA on upcoming events and other resources.
I would like to receive email messages from NWMOA about Events, Newsletter or Activities*
- Yes
- No
Authorization for receiving publication email notification from NWMOA.
(applies to all email addresses on this form)
I 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)*
- Yes
- No
Volunteer Opportunities
Committee 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 Bio
Company Description
Member Bio
Membership Level
Public 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 member
Membership Type*
- 1A - Public Agencies, Industrial Users and Water Suppliers, $360
- 1B - Operator Individual Membership, $60
- 2A - Manufacturers, Suppliers, Consulting Firms, $480
- 2B - Small Firms - Fewer than 5 employees, $240
- 3A - Individual employed by a Public Agency who is not an Operator, $60
- 3B - Individuals affiliated with a paid Division 2 Member, $120
- 3C - Other Interested Individuals (not affiliated with any organization, $150
- 3D - Full-Time Student/Intern (must submit proof along with application), $25
Total
$0.00
Included Member 1
Salutation - Included Member 1
First Name - Included Member 1
Middle Initial - Included Member 1
Last Name - Included Member 1
Job Title - Included Member 1
Email Address - Included Member 1
Member Bio - Included Member 1
I 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*
- Yes
- No
Included Member 2
Salutation- Included Member 2
First Name - Included Member 2
Middle Initial - Included Member 2
Last Name - Included Member 2
Job Title - Included Member 2
Email Address - Included Member 2
Member Bio - Included Member 2
I 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*
- Yes
- No
Included Member 3
Salutation - Included Member 3
First Name - Additional Member 3
Middle Initial - Included Member 3
Last Name - Included Member 3
Job Title - Included Member 3
Email Address - Included Member 3
Member Bio - Included Member 3
I 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*
- Yes
- No
Included Member 4
Salutation - Included Member 4
First Name - Included Member 4
Middle Initial - Included Member 4
Last Name - Included Member 4
Job Title - Included Member 4
Email Address - Included Member 4
Member Bio - Included Member 4
I 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*
- Yes
- No
Included Member 5
Salutation - Included Member 5
First Name - Included Member 5
Middle Initial - Included Member 5
Last Name - Included Member 5
Job Title - Included Member 5
Email Address - Included Member 5
Member Bio - Included Member 5
I 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*
- Yes
- No
Division IB - Additional Members
Price: $60.00
How many Additional Members will you include in this application?
Count
Division IIB - Additional Members
Price: $120.00
How many Additional Members will you include in this application?
Count
Division IIIA - Additional Members
Price: $60.00
How many Additional Members will you include in this application?
Count
Division IIIB - Additional Members
Price: $120.00
How many Additional Members will you include in this application?
Count
Total
$0.00
Additional Member 1
Salutation - Additional Member 1
First Name - Additional Member 1
Middle Initial - Additional Member 1
Last Name - Additional Member 1
Job Title - Additional Member 1
Email Address - Additional Member 1
Member Bio - Additional Member 1
I 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*
- Yes
- No
Additional Member 2
Salutation - Additional Member 2
First Name - Additional Member 2
Middle Initial - Additional Member 2
Last Name - Additional Member 2
Email Address - Additional Member 2
Job Title - Additional Member 2
Member Bio - Additional Member 2
I 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*
- Yes
- No
Additional Member 3
Salutation - Additional Member 3
First Name - Additional Member 3
Middle Initial - Additional Member 3
Last Name - Additional Member 3
Email Address - Additional Member 3
Job Title - Additional Member 3
Member Bio - Additional Member 3
I 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*
- Yes
- No
Additional Member 4
Salutation - Additional Member 4
First Name - Additional Member 4
Middle Initial - Additional Member 4
Last Name - Additional Member 4
Email Address - Additional Member 4
Job Title - Additional Member 4
Member Bio - Additional Member 4
I 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*
- Yes
- No
Additional Member 5
Salutation - Additional Member 5
First Name - Additional Member 5
Middle Initial - Additional Member 5
Last Name - Additional Member 5
Email Address - Additional Member 5
Job Title - Additional Member 5
Member Bio - Additional Member 5
I 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*
- Yes
- No
Additional IIIA Member 1
Salutation - Additional IIIA Member 1
First Name - Additional IIIA Member 1
Middle Initial - Additional IIIA Member 1
Last Name - Additional IIIA Member 1
Email Address - Additional IIIA Member 1
Job Title - Additional IIIA Member 1
Member Bio - Additional IIIA Member 1
I 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*
- Yes
- No
Additional IIIA Member 2
Salutation - Additional IIIA Member 2
First Name - Additional IIIA Member 2
Middle Initial - Additional IIIA Member 2
Last Name - Additional IIIA Member 2
Email Address - Additional IIIA Member 2
Job Title - Additional IIIA Member 2
Member Bio - Additional IIIA Member 2
I 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*
- Yes
- No
Additional IIIA Member 3
Salutation - Additional IIIA Member 3
First Name - Additional IIIA Member 3
Middle Initial - Additional IIIA Member 3
Last Name - Additional IIIA Member 3
Email Address - Additional IIIA Member 3
Job Title - Additional IIIA Member 3
Member Bio - Additional IIIA Member 3
I 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*
- Yes
- No
Additional IIIA Member 4
Salutation - Additional IIIA Member 4
First Name - Additional IIIA Member 4
Middle Initial - Additional IIIA Member 4
Last Name - Additional IIIA Member 4
Email Address - Additional IIIA Member 4
Job Title - Additional IIIA Member 4
Member Bio - Additional IIIA Member 4
I 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*
- Yes
- No
Additional IIIA Member 5
Salutation - Additional IIIA Member 5
First Name - Additional IIIA Member 5
Middle Initial - Additional IIIA Member 5
Last Name - Additional IIIA Member 5
Email Address - Additional IIIA Member 5
Job Title - Additional IIIA Member 5
Member Bio - Additional IIIA Member 5
I 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*
- Yes
- No
Payment Information
Payment Method*
- Credit Card - Online Payment
- Credit Card - Use Card on File
- Credit Card - Call Me
- eCheck (Bank Wire w/o processing fee) - Online Payment
- Check
- Invoice
If paying by Check, make payable to Northwest Membrane Operator Association, and mail to 12592 West Explorer Dr., Ste. 200, Boise, ID 83713.
Comments & Captcha
If you would like a copy of the invoice/receipt sent to another*
- Yes, send copy of invoice/receipt to:
- No, don't need a copy sent
If yes, you would like a copy of the invoice/receipt sent to another other than the attendee please enter information below.
Name*
First Last
Email Address*
Questions/Comments
Captcha

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