Alaska Water Well Association <http://www.alaskawaterwellassoc.org/index.htm>
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:
Top of Form 1 Bottom of Form 1 Wholesaler, Manufacturer, & Supplier, corporate $ 175.00
Top of Form 2 Bottom of Form 2 Contractor, corporate $ 125.00
Top of Form 3 Bottom of Form 3 Associate $ 50.00
Top of Form 4 Bottom of Form 4 Technical $ 20.00
Top of Form 5 Bottom of Form 5 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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