2020- 2021 Membership Renewal Form

Member Information

First Name *

Last Name *

Company Name *

Mailing Address *

Address Line 2

City *

State *

Zip Code *

Phone *

Alternate Phone

Email Address *

License #

Mark all that apply: *

Pump Installer

Water Well Driller

Water Well Drilling Rig Operator

Heat Exchange Driller (or Heat Exchange Drilling Rig Operator)

Plumbing License: Plumbing License:

Membership Renewal Level

Full Membership: $150
Licensed Water Well Driller or Pump Installer

Full Membership

Associate Membership: $100

If other, please describe.

Website Advertising

Website Advertising

$180 = Large Banner Ad (336 x 280 pixels)

$120 = Small Banner Ad (336 x 135 pixels)

Printed Newsletter Options

$1,300 = Full Page Ad Full Year

$475 = Full Page Ad Single Issue

$850 = Half Page Ad Full Year

$250 = Half Page Ad Single Issue

$600 = Quarter Page Ad Full Year

$175 = Quarter Page Ad Single Issue

Donations

Scholarship Fund:

Current Total:

$0.00