Membership Form – Massachusetts Water Environment Association

Personal Information

Membership Type(Required)

Name of Person Filling out Form(Required)

First Last

Email to Receive Receipt/Invoice(Required)

Are you renewing?

MAWEA ID #

Name(Required)

First Last

Home Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Email(Required)

Employment Information

Title

Certification Grade

State

State Certification #

Company/Facility Name

Company Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Where do you want to receive mail?(Required)

Home Address

Work Address

Would you be interesting in volunteering on an MAWEA committee or board?(Required)

Yes, contact me with more information

No, not at this time

Group Membership Details

List Members(Required)

First Name

Last Name

Street

City/Town

State

Zip Code

Telephone

Please use the + sign to add more rows

Payment Information

Membership Dues (per person)

Price: $50.00

If this is a group membership, please change the quantity to amount of people in your group.

Total

Method of Payment(Required)

Credit Card

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name