Please fill in your info. online,
then print out this form and mail it.

Name   Title  

Home Address  

Employed by      

Employer Address

Preferred Mail Address - Please check if it is:    WORK   HOME

Daytime Phone ( ) -    FAX ( ) -

E-mail

Recommended by

If Applicable:

Operator Certification Grade

Operator License Number

Individual Membership:

$75–Active      $75–Affiliate       $30–Student

My utility also wishes to enroll in the Utility Advantage Program to support MWWA’s advocacy and outreach initiatives:  

Name of Participating Utility:

   $100—Less than 500 population served

   $500—501-2,500 population served

   $1,000—2,501-10,000 population served

   $2,000—10,001-50,000 population served

   $2,500—Over 50,000 population served

I am an affiliate member who wants to support MWWA’s advocacy
and outreach initiatives with the enclosed: $


Applicant's Signature: _______________________________________

DATE / / MM/DD/YY

Please send the completed application, along with a check
made out to Massachusetts Water Works Association for the amount checked above to:

MASSACHUSETTS WATER WORKS ASSOCIATION
P. O. Box 1064
ACTON, MA 01720
Phone: (978) 263-1388
Fax: (978) 263-1376
Email: mwwa@verizon.net
Website: www.masswaterworks.org