Michigan Onsite Wastewater Recycling Association
MOWRA • PO BOX 708 • HASLETT, MI 48840
2006 MEMBERSHIP APPLICATION
Membership Information:
Name:
________________________________ Company/Agency: _________________________________________Member Category (circle one):
Site Evaluator – Soil Scientist – Designer – Engineer – Supplier – Vendor – Installer – Contractor – Operator – Manager – Maint/Service Provider – Compliance Monitor – Regulator – Academic – Researcher – Other – Manufacturer – Student – VIP (Very Interested Party – i.e. legislator, developer, builder, etc.)Address:
_________________________________ City: __________________ State: ______ Zip: ____________Voice Phone:
____________________ Fax*: Email: _____________________________*Please note any limits to fax receiving time.
Referred By
:_____________________________________(New members – please list who referred you to MOWRA)Membership in the Michigan Onsite Wastewater Recycling Association enrolls you as a constituent member of the National Onsite Wastewater Recycling Association. Membership dues are for the calendar year. Membership renewal invoices are sent out at the beginning of each calendar year.
Membership Dues $75.00 Full member ($50.00 Regulator)
MOWTEC Contribution _________
(Optional - $25.00 suggested)
Total Enclosed _________
Please make checks payable to MOWRA and return to: MOWRA, PO Box 708, Haslett, MI 48840-0708