Associate Member Application

Company Name*

Subsidiary?*

AKA/DBA

Parent Company

Number of Employees

Website

Gross Annual Revenue from the Water/Wastewater Industry: $

Primary Contact Information

Primary Contact Name*

First Last

Email*

Mailing Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Phone*

Fax

Billing Contact Information

Name*

First Last

Email*

Mailing Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Phone*

Fax

Exhibit/Marketing Contact Information

Name

First Last

Email

Title

Address

Street Address City State / Province / Region ZIP / Postal Code Country

Phone

Company Description

Description (30 words or less)

Please upload your logo(s).

Drop files here or

Max. file size: 256 MB.

Please upload a color version and white version of your company’s logo for marketing usage. Preferred files types: .eps, .ai but .png are accepted. If you have any questions or issues about logos, please email communications@nrwa.org.

Products & Services

Please select up to 5 categories that best represent your company.

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