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 PhoneFaxEmail 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.Email Notifications*Yes, I authorize receiving publication email notificationsNo, I would not like to receive publication email notifications (opt-out)Authorization for receiving publication email notification from SWMOA.(applies to all email addresses on this form)Data Sharing*Opt-In: It is ok to share my contact information (name, job title, company, address, email, phone, etc.) with SWMOA Board, Event Sponsors, Speakers, Moderators & Attendees.Opt-Out: Do not share my address, email or phone. Outside of SWMOA Administration, only my name, title and company will be shared with SWMOA Board, Event Sponsors, Speakers, Moderators & Attendees. Volunteer OpportunitiesCommittee Preferences Audit/Finance Awards Bylaws/Policies Legislative Membership Nominations/Election Operator Certification Publications/Newsletter Program/Technology Transfer Public Relations 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, $3001B - Operator Individual Membership, $752A - Manufacturers, Suppliers, Consulting Firms, $4002B - Small Firms - Fewer than 5 employees, $2003A - Affiliate of Divison 1A Member (not an Operator), $753B - Affiliate of Division 2 Member, $1003C - Interested Individuals (not affiliated with any organization), $1253D - Full-Time Student/Intern - 1st Time Member, $03D - Full-Time Student/Intern - Renewing Member, $25Supporting DocumentPlease upload your supporting proof of enrollment document.Affiliate Members Price: $0.00 How many Affiliate Members will you include in this application?Count012345Total $0.00 Affiliate Member 1Salutation - Affiliate 1Mr.Mrs.Ms.Dr.First Name - Affiliate 1Middle Initial - Affiliate 1Last Name - Affiliate 1Job Title - Affiliate 1Email Address - Affiliate 1 Member Bio - Affiliate 1Data Sharing - Affiliate 1*Opt-In: It is ok to share my contact information (name, job title, company, address, email, phone, etc.) with SWMOA Board, Event Sponsors, Speakers, Moderators & Attendees.Opt-Out: Do not share my address, email or phone. Outside of SWMOA Administration, only my name, title and company will be shared with SWMOA Board, Event Sponsors, Speakers, Moderators & Attendees. Affiliate Member 2Salutation - Affiliate 2Mr.Mrs.Ms.Dr.First Name - Affiliate 2Middle Initial - Affiliate 2Last Name - Affiliate 2Job Title - Affiliate 2Email Address - Affiliate 2 Member Bio - Affiliate 2Data Sharing - Affiliate 2*Opt-In: It is ok to share my contact information (name, job title, company, address, email, phone, etc.) with SWMOA Board, Event Sponsors, Speakers, Moderators & Attendees.Opt-Out: Do not share my address, email or phone. Outside of SWMOA Administration, only my name, title and company will be shared with SWMOA Board, Event Sponsors, Speakers, Moderators & Attendees. Affiliate Member 3Salutation - Affiliate 3Mr.Mrs.Ms.Dr.First Name - Affiliate 3Middle Initial - Affiliate 3Last Name - Affiliate 3Job Title - Affiliate 3Email Address - Affiliate 3 Member Bio - Affiliate 3Data Sharing - Affiliate 3*Opt-In: It is ok to share my contact information (name, job title, company, address, email, phone, etc.) with SWMOA Board, Event Sponsors, Speakers, Moderators & Attendees.Opt-Out: Do not share my address, email or phone. Outside of SWMOA Administration, only my name, title and company will be shared with SWMOA Board, Event Sponsors, Speakers, Moderators & Attendees. Affiliate Member 4Salutation - Affiliate 4Mr.Mrs.Ms.Dr.First Name - Affiliate 4Middle Initial - Affiliate 4Last Name - Affiliate 4Job Title - Affiliate 4Email Address - Affiliate 4 Member Bio - Affiliate 4Data Sharing - Affiliate 4*Opt-In: It is ok to share my contact information (name, job title, company, address, email, phone, etc.) with SWMOA Board, Event Sponsors, Speakers, Moderators & Attendees.Opt-Out: Do not share my address, email or phone. Outside of SWMOA Administration, only my name, title and company will be shared with SWMOA Board, Event Sponsors, Speakers, Moderators & Attendees. Affiliate Member 5Salutation - Affiliate 5Mr.Mrs.Ms.Dr.First Name - Affiliate 5Middle Initial - Affiliate 5Last Name - Affiliate 5Job Title - Affiliate 5Email Address - Affiliate 5 Member Bio - Affiliate 5Data Sharing - Affiliate 5*Opt-In: It is ok to share my contact information (name, job title, company, address, email, phone, etc.) with SWMOA Board, Event Sponsors, Speakers, Moderators & Attendees.Opt-Out: Do not share my address, email or phone. Outside of SWMOA Administration, only my name, title and company will be shared with SWMOA Board, Event Sponsors, Speakers, Moderators & Attendees. 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