Alaska Water Well Association
Membership Application
Affiliated with the
National Ground Water Association
To print this application to mail or fax, click "print" on your browser.

Name:

_________________________________________________________________________

Company:

_________________________________________________________________________

Email:

_________________________________________________________________________

Address:

_________________________________________________________________________

City:

_____________________

State: _________

Zip Code: ___________

Telephone:

_____________________

Fax: ___________________________________

Corporate Members Only: list 2 additional names representing firm.
1. ____________________________________________________________________________________
2. ____________________________________________________________________________________
Sponsored By: ___________________________________________________________________________

Check your category below:

Wholesaler, Manufacturer, & Supplier, corporate	$ 175.00
Contractor, corporate	$ 125.00
Associate	$ 50.00
Technical	$ 50.00
Additional, corporate members after initial dues	$ 25.00

Mail Application to: Alaska Water Well Association P.O Box 113156 Anchorage, Alaska 99511-3156 Attach a check for dues

Fax Application to: We will keep your application on file until payment is received, upon which we will notify you of your approved application. Thank You

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