Streamline - Summer 2015 - (Page 53)

Virginia Rural Water Association MEMBERSHIP APPLICATION Name of Organization: ____________________________________________________________________________________________ Contact Person (Delegate): ______________________________ Title: _____________________________________________________ Mailing Address: _________________________________________________________________________________________________ Physical Address: _________________________________________________________________________________________________ City/State/Zip: ________________________________________ County: ___________________________________________________ Phone: _______________________________________________ Fax: ______________________________________________________ Email: __________________________________________________________________________________________________________ All members are billed annually on July 1. Members joining after September will pay pro-rated amount for the remainder of the year. Please follow the charts below to determine your membership rate. ________ ________ ________ ________ Membership Type Individual: Class VI Operators: Corporate: Associate: $75/yr. $150/yr. $400/yr. $300/yr. ________ # of Connections* Water/Wastewater (Based on # of Connections*) ________ * Voting: $300/yr. 1-1000 Connection $350/yr. 1001-2000 $400/yr. 2001-3000 $450/yr. 3001-4000 $500/yr. 4001-up Total Amount Due: __________ Membership Categories: VOTING: A non-profit, public entity serving a population of less than 10,000. This includes counties, county schools systems, service authorities, water and sewer departments and generally any non-profit system with board elected from within. ASSOCIATE: A private or investor-owned utility or servicing a population of 10,000 or more. This includes state and federal agencies and other private utilities. CORPORATE: Entity that supports the water and/or wastewater industry. The annual membership fee is $400 for a parent company; $250 for each subsidiary; with a maximum umbrella of $1,000 or they may take advantage of the New "Booster Club" package. Individual Member Join between July 1-Sept. 30 = $75 Join between Oct. 1-Dec. 31= $56.25 Join between Jan. 1-March 30 = $37.50 Join between April 1-June 30 = $18.75 Class VI Operator Member Join between July 1-Sept. 30 = $150 Join between Oct. 1-Dec. 31= $112.50 Join between Jan. 1-March 30 = $75 Join between April 1-June 30 = $37.50 Voting: Water/Wastewater (Based on # of Connections) 1-1000 1001-2000 2001-3000 Join between July 1-Sept. 30 $300 $350 $400 Join between Oct. 1-Dec. 31 $225 $262.50 $300 Join between Jan. 1-March 30 $150 $175 $200 Join between April 1-June 30 $75 $87.50 $100 3001-4000 $450 $337.50 $225 $112.50 Associate Members Join between July 1-Sept. 30 = $300 Join between Oct. 1-Dec. 31= $225 Join between Jan. 1-March 30 = $150 Join between April 1-June 30 = $75 4001-up $500 $375 $250 $125 Prorated Membership Dues Individual $ ___________ Class VI $ ____________ Associate $ ____________ Voting $ ______________ # Connections _________ Total Amount Due = ____ Payment Information Payment Methods: Check: ____________ Credit Card Visa : ___________ MC: _______________ (Make checks payable to: VRWA) Card #: ___________________________ Expiration Date: ____________ CID#: __________________ (3-digit # on back of the card) Name as it appears on card: _______________________________________________________________________ (Please print clearly) Billing Address: ______________________________________ City: ___________________ State: ______ Zip: _________________ Signature: ______________________________________________________________________________________________________ Email Address to Send Receipt: ____________________________________________________________________________________ Total to be Charged: $ ____________________ Check Number: ______________ Total Amount Enclosed: $ ____________________ Mail/Fax completed application to: Virginia Rural Water Association | 2138 Sycamore Avenue | Buena Vista, Virginia 24416 | Fax: (540) 261-2465 Questions? Call (540) 261-7178 or visit www.vrwa.org http://vrwa.org/

Table of Contents for the Digital Edition of Streamline - Summer 2015

From the President: A Disinfection Byproducts Odyssey
From the Executive Director: It’s Over
Importance of Professional Relationships in the Water and Wastewater Industry
Spring Cleaning … All Year Long
Region Meetings: the Next Big Thing
Preventing Heat-Related Illnesses
Virginia Source Water
USDA Rural Development
A Successful Model for Waterworks
Professional Licensing Update: News You Can Use
NRWA Recap
Tank Team Tackles Water Distribution
VRWA 2015 Conference Highlights
Town of Lovettsville Wins the ‘Great Water Taste Contest’
Throwing My Loop: Helpers in Our Path
Wastewater Crossword
VRWA Booster Club
e-Learning Benefits
Membership Application
Do You Know What Your VRWA Benefits Are?
VRWA Mailbag
New Members
Board of Directors
VRWA Committees
Index to Advertisers/Ad.com

Streamline - Summer 2015

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