FRWA Active Membership Application Please detach and mail application below with your payment: Name of System/Firm___________________________________________________________________________ Contact Person_____________________________________ Title_______________________________________ Mailing Address_______________________________________________________________________________ Physical Address_______________________________________________________________________________ City____________________________ County_____________________State________Zip____________________ Phone___________________________Fax________________________Email______________________________ DEP Public Water System Identification Number (PWSID)______________________________________________ DEP Wastewater System Identification Number (GMSID)_______________________________________________ Active Membership Base Rate $ 125 This is the base rate for Water, Wastewater and Water/Wastewater Active membership. Number of Water Connections____________________ x 30¢ $_____________ Multiply the number of water connections (total number of buildings served) by 30¢. Number of Wastewater Connections_______________ x 30¢ $_____________ Multiply the number of wastewater connections (total number of buildings served) by 30¢. AMOUNT ENCLOSED $_____________ The maximum amount of annual dues in each category (regardless of the amount of connections) is: Water Only: $410 Wastewater Only: $325 Water/Wastewater: $560 Membership dues may be paid by company check or credit card. FRWA does not accept purchase orders. If you wish to pay online, please go to our website and click on https://floridaruralwaterflassoc.wliinc15.com/join-us/ application.aspx. If you wish to pay by company check, please mail the completed application with payment to the address above. Thank you in advance for your support of FRWA.https://floridaruralwaterflassoc.wliinc15.com/join-us/