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. 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 member Full-Time Student/Intern 3D - must submit proof along with applicationMembership 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), $25Submit proof of student full time status*Please upload your supporting proof of enrollment document. 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*Enter member's email address Website Billing Contact InformationEnter billing contact information, if applicableBilling Contact NameBilling 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 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 1 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 2 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 3 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 4 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 5 Additional MembersDivision IB - Additional MembersHow many Additional Members will you include in this application? Price: $60.00 Count012345 Division IIB - Additional MembersHow many Additional Members will you include in this application? Price: $120.00 Count012345 Division IIIA - Additional MembersHow many Additional Members will you include in this application? Price: $60.00 Count012345 Division IIIB - Additional MembersHow many Additional Members will you include in this application? Price: $120.00 Count012345Total $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 1Additional 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 2Additional 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 3Additional 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 4Additional 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 5Additional 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 1Additional 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 2Additional 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 3Additional 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 4Additional 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 5 Total $0.00 Payment InformationPayment Method*Credit Card - Online PaymenteCheck (Bank Wire w/o processing fee) - Online PaymentCheckInvoiceMail checks payable to: Northwest Membrane Operator Association (NWMOA) 2409 SE Dixie Hwy., Stuart, FL 34996 Comments & CaptchaQuestions/Comments CAPTCHAPlease refer to NWMOA’s Privacy Policy if you have any questions regarding your preferences.