Associate Application - MsRWA | Mississippi Rural Water Association

Associate Member: Any person, firm, partnership, corporation or organization adhering to the purpose of the association may become an associate member.
Date
MM slash DD slash YYYY
MsRWA Member #
(If you have please put your MsRWA Member Number here.)
Name of Organization*
TIN#*
Mailing Address*
Street Address City State ZIP Code
Phone*
Fax
Email*
Website
Contact Person*
First Last
Cell Phone
Type of Business or Services*
Service Area*
Membership Dues
Dues are payable at the time application is submitted. Membership dues will expire annually on December 31st. However to be in the Yearly Membership Directory this form must be returned by November 30 of each year and dues MUST be paid by January 1st.
Annual Dues*
Click here to see VIP level details.
- Basic Membership ($400)
- Silver Membership ($2000)
- Gold Membership ($2650)
- Platinum Membership ($2950)
- Diamond Membership ($3500)
Total
$0.00
Preferred payment method*
- Pay online w/ credit card
- Mail a check
- Other
Phone
This field is for validation purposes and should be left unchanged.

Membership Dues