Future of Water - Fall Issue | 21
Rural Water Association of Arizona
Providing the highest quality training and mechanical assistance in rural water
and wastewater usage throughout Arizona, and representing the legislative
and regulatory interests of our members.
SYSTEM & INDIVIDUAL MEMBERSHIP
Application / Renewal Form
(
Companies and Agencies please use the Associate form)
Please print clearly and complete all items.
For Association Use Only:
Date Received _ _______________________
Follow-up _____________________________
Rural Water Association of Arizona
1075
S. Idaho Road, Suite #190
Tucson, AZ 85745
(480) 982-0301
Primary Contact Name _ ______________________________________________________________________________________________________________________
System / Organization_____________________________________________________________________________________NumberofConnections______________
Address ___________________________________________________________ City ____________________________ State ______________ Zip _________________
Phone ________________________________Fax _________________________________ Email_______________________________________________________________
System members are water and sanitation districts, non-profit corporations (cooperatives, mutual domestics), or rural
municipalities engaged in the distribution of water or treatment of sewage for rural residents.
A Voting Member is:
A public or private water and wastewater, and other types of utilities and municipalities with less than 10,000
population, engaged in the transportation, distribution, and/or sale of utility services in the rural area of the State of Arizona.
A Non-Voting Member is:
Any person, firm, corporation, organization or municipality serving more than 10,000 population and
adhering to the purposes of the Association and desiring to assist in the work of the Association may become a non-voting member.
Check # ___________________ VISA _ ________________ MasterCard _ __________ Discover _______________ American Express ___________________
Card # _ ________________________________________________________________________ Exp. _ _____________ Card Verification Code _ _________________
Name on Credit Card _ ___________________________________________________________________________________________________________________________
Cardholder Signature _ ___________________________________________________________________________________________________________________________
Make checks payable to:
Rural Water Association of Arizona
Individual Membership Fee: $75.00 (per year)
The base membership fee is $75.00 with a $0.55 per connection fee. (up to $750.00 annually)
Base Fee: $75.00
Number of connections _______ x $0.55 cents = $________
Amount from the previous line_ _________ + $75.00 = $_ __________ (up to a maximum of $750.00)
(
This is the amount that you will be charged for your yearly membership fee.)