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Contact Info
Name (First & Last Name)
Company (if applicable)
Address
City State Zip
County
Phone(s) (with area code)
Email Address
Website Address (if applicable)
Contractor Categories
(check all that apply)
Certified Water Testing Facility
Engineer/ Scientist
Environmental/ Geotechnical Driller
Geothermal Driller
Pump Service
Supplier/ Manufacturer
Water Treatment Installer
Water Well Driller
Corporate Membership - $250
(More than 2 employees)
*Additional voting members $95.00 each

Maximum of three (3) named members will be listed in membership roster as voting members.

1. Name
Email
2. Name
Email
3. Name
Email
Additional voting member ($95.00)
4.* Name
Email
Additional voting member ($95.00)
5.* Name
Email
Additional voting member ($95.00)
6.* Name
Email
Individual Membership - $100.00
(Scientist, Engineer, Groundwater Professional, etc.)

Member will be listed in membership roster as a voting member.

Name
Email
Associate Membership - $200.00
(Manufacturer)

Member will be listed as a non-voting member. Includes listing of name and three products in quarterly newsletter.

Company Listing Name
Product
Product
Product
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Credit Card / PayPal
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Paying by Check?
Make check out to "New Jersey Ground Water Association" and mail to
NJGWA, PO Box 24, West Creek, NJ 08092

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