Join SWMOA – Membership Application To apply for membership, fill out and submit the form below, or download a printable application form that you print, fill out and mail. MemberPlease refrain from using all caps/uppercase letters, please use sentence structure letter case.Salutation*Mr.Mrs.Ms.Dr.First Name*Middle InitialLast Name*SuffixJob Title* Organization & AddressOrganization*Mailing Address*City*State/ProvinceZIP/Postal CodeCountry* Contact InformationTelephone*Cell PhoneEmail Address*Enter applicant's email address Website Billing Contact InformationEnter billing contact information, if applicableBe advised, SWMOA’s mailing address has changed: 2409 SE Dixie Hwy., Stuart, FL 34996Billing Contact NameBilling Contact Email AddressEnter billing contact's email address, if applicable Billing Contact Telephone Please send copy of the invoice/receipt to Billing Contact Volunteer OpportunitiesCommittee Preferences Awards Legislative / Regulatory Membership Operator Certification Program / Technology Transfer Publications / Newsletter Public Relations / Social Media Other Interests I am interested in running for a position on the SWMOA Board of Directors. I am interested in presenting at a Symposium, Workshop, or hosting an event at my facility. Company Description & Member BioCompany DescriptionPlease provide one paragraph – 150 words or lessMember BioPlease provide one paragraph – 150 words or less Membership LevelPublic Agencies, Industrial Users and Water Suppliers: 1A - membership includes 1 primary member & 5 additional 1B or 3A affiliate members Manufacturers, Suppliers, Consulting Firms: 2A - membership includes 1 primary member & 3 additional 3B affiliate members 2B - membership includes 1 primary member & 1 additional 3B affiliate member Full-Time Student/Intern 3D - must submit proof along with application Membership Type*1A - Public Agencies, Industrial Users and Water Suppliers, $3601B - Operator Individual Membership, $752A - Manufacturers, Suppliers, Consulting Firms, $4802B - Small Firms - Fewer than 5 employees, $2403A - Affiliate of Divison 1A Member (not an Operator), $753B - Affiliate of Division 2 Member, $1203C - Interested Individuals (not affiliated with any organization), $1503D - Full-Time Student/Intern - 1st Time Member, $03D - Full-Time Student/Intern - Renewing Member, $25Submit proof of student full time status*Please upload your supporting proof of enrollment document.Included Members Price: $0.00 How many Included Members will you include in this application?Count - Included Members (Div. 1)012345 Count - Included Members (Div. 2A)0123 Count - Included Members (Div. 2B)01 Division 1B - Additional Members Price: $75.00 How many Additional Members will you include in this application?Count - Additional 1B Members012345 Division 3A - Additional Members Price: $75.00 How many Additional Members will you include in this application?Count - Additional 3A Members012345 Division 3B - Additional Members Price: $120.00 How many Additional Members will you include in this application?Count - Additional 3B Members012345 Total $0.00 Included Member 1Salutation - Included Member 1Mr.Mrs.Ms.Dr.First Name - Included Member 1Middle Initial - Included Member 1Last Name - Included Member 1Job Title - Included Member 1Email Address - Included Member 1 Member Bio - Included Member 1 Included Member 2Salutation - Included Member 2Mr.Mrs.Ms.Dr.First Name - Included Member 2Middle Initial - Included Member 2Last Name - Included Member 2Job Title - Included Member 2Email Address - Included Member 2 Member Bio - Included Member 2 Included Member 3Salutation - Included Member 3Mr.Mrs.Ms.Dr.First Name - Included Member 3Middle Initial - Included Member 3Last Name - Included Member 3Job Title - Included Member 3Email Address - Included Member 3 Member Bio - Included Member 3 Included Member 4Salutation - Included Member 4Mr.Mrs.Ms.Dr.First Name - Included Member 4Middle Initial - Included Member 4Last Name - Included Member 4Job Title - Included Member 4Email Address - Included Member 4 Member Bio - Included Member 4 Included Member 5Salutation - Included Member 5Mr.Mrs.Ms.Dr.First Name - Included Member 5Middle Initial - Included Member 5Last Name - Included Member 5Job Title - Included Member 5Email Address - Included Member 5 Member Bio - Included Member 5 Additional Member 1Salutation - Additional Member 1Mr.Mrs.Ms.Dr.First Name - Additional Member 1Middle Initial - Additional Member 1Last Name - Additional Member 1Job Title - Additional Member 1Email Address - Additional Member 1 Member Bio - Additional Member 1 Additional Member 2Salutation - Additional Member 2Mr.Mrs.Ms.Dr.First Name - Additional Member 2Middle Initial - Additional Member 2Last Name - Additional Member 2Job Title - Additional Member 2Email Address - Additional Member 2 Member Bio - Additional Member 2 Additional Member 3Salutation - Additional Member 3Mr.Mrs.Ms.Dr.First Name - Additional Member 3Middle Initial - Additional Member 3Last Name - Additional Member 3Job Title - Additional Member 3Email Address - Additional Member 3 Member Bio - Additional Member 3 Additional Member 4Salutation - Additional Member 4Mr.Mrs.Ms.Dr.First Name - Additional Member 4Middle Initial - Additional Member 4Last Name - Additional Member 4Job Title - Additional Member 4Email Address - Additional Member 4 Member Bio - Additional Member 4 Additional Member 5Salutation - Additional Member 5Mr.Mrs.Ms.Dr.First Name - Additional Member 5Middle Initial - Additional Member 5Last Name - Additional Member 5Job Title - Additional Member 5Email Address - Additional Member 5 Member Bio - Additional Member 5 Payment InformationPayment Method*Credit Card - Online PaymenteCheck (Bank Wire w/o processing fee) - Online PaymentCheckInvoiceIf paying by check, make payable to Southwest Membrane Operator AssociationMail to: 2409 SE Dixie Hwy., Stuart, FL, 34996. 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