Membership Application

The Virginia Water Well Association values your membership. One to three people in your company can become members for $150.00. After the first three people the cost is $25.00 per person. Help us to build our membership and make the Virginia Water Well Association stronger by getting as many people in your company involved in the association as possible.

Complete the form below and send it along with payment to:

VWWA

P.O. Box 1128

New Market, VA 22844

1. New Member:               Renewing Member:                         Date:______

2. Company:                                                                                        

3. Street/P.O. Box:                                                                                            County:_________________                                 

4. Town/State/Zip: _____________________________________________________________________                                                                                                                                           

5. Phone:                                                                          Fax: ____________________________________                                                                         

6. E-Mail: __________________________________________________________                                                                                                                                                        

7. Membership:

            1 to 3 individuals per company $150.00

            Additional people (after first 3) $25.00

8. List the people who will become members. Each member will receive VWWA mailings. If the member has a mailing address other than the address given above, please give the other address. Use back of application if needed.

Please Print Names

Primary Contact: ______________________________                                                                                                                                             

Member:                                                                   Member:____________________________________                                                                        

Member:                                                                   Member:____________________________________                                                                          

Member:                                                                   Member: ____________________________________                                                                         

If you have any questions please call VWWA office at: 540-740-3329

 Strength in numbers is the key!