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. Primary MemberSalutation*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* Website Communication and Data Sharing PreferenceSWMOA has been diligent in Data Security and being compliant with US and other Nations regulations in sharing your contact information as well as receiving email communications from SWMOA on upcoming events and other resources.I would like to receive email messages from SWMOA about Events, Newsletter or Activities*YesNoAuthorization for receiving publication email notification from SWMOA.(applies to all email addresses on this form)I would like to network with SWMOA Members, Operators, Attendees, Speakers, Moderators, Exhibitors, Sponsors or Board, please share my contact information (cell phone # will not be shared)*YesNo 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, $25Supporting DocumentPlease upload your supporting proof of enrollment document.Additional Members Price: $0.00 How many Additional Members will you include in this application?Count012345Division IB - Additional Members Price: $75.00 Quantity: How many Additional Members will you include in this application?Count012345678910Division IIB - Additional Members Price: $120.00 How many Additional Members will you include in this application?Count012345678910Total $0.00 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 1I would like to network with SWMOA Members, Operators, Attendees, Speakers, Moderators, Exhibitors, Sponsors or Board, please share my contact information (cell phone # will not be shared) - Additional 1*YesNo 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 2I would like to network with SWMOA Members, Operators, Attendees, Speakers, Moderators, Exhibitors, Sponsors or Board, please share my contact information (cell phone # will not be shared) - Additional 2*YesNo 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 3I would like to network with SWMOA Members, Operators, Attendees, Speakers, Moderators, Exhibitors, Sponsors or Board, please share my contact information (cell phone # will not be shared) - Additional 3*YesNo 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 4I would like to network with SWMOA Members, Operators, Attendees, Speakers, Moderators, Exhibitors, Sponsors or Board, please share my contact information (cell phone # will not be shared) - Additional 4*YesNo Additional Member 5Additional Member 6Salutation - Additional Member 5Mr.Mrs.Ms.Dr.Salutation - Additional Member 6Mr.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 5I would like to network with SWMOA Members, Operators, Attendees, Speakers, Moderators, Exhibitors, Sponsors or Board, please share my contact information (cell phone # will not be shared) - Additional 5*YesNo Payment InformationPayment Method*Credit Card - Online PaymenteCheck (Bank Wire w/o processing fee) - Online PaymentCheckInvoiceIf paying by Check, make payable to Southwest Membrane Operator Association, and mail to 1035 East Vista Way, #103, Vista, CA 92084-4606. Comments & CaptchaIf you would like a copy of the invoice/receipt sent to another*Yes, send copy of invoice/receipt to:No, don't need a copy sentIf yes, you would like a copy of the invoice/receipt sent to another other than the attendee please enter information below.Name* First Last Email Address* Questions/CommentsCaptcha