MOWRA

C/O Bill Gregory, Sec/Treas

4300 Faussett Road

Howell, MI 48855

MEMBERSHIP APPLICATION

Membership Information:

Name:  ________________________________

Company/Agency:  _____________________________

Member Category (circle one):  Site Evaluator – Soil Scientist – Designer – Engineer – Supplier – Vendor – Installer – Contractor – Operator – Manager – Maint/Service Provider – Compliance Monitor – Regulator – Academic – Researcher – Other – Manufacturer – Student – VIP (Very Interested Party – i.e. legislator, developer, builder, etc.)

Address:  _________________________________  City:  __________________  State: ____  Zip: ________

Business Phone: _______________                                      Fax: _______________

Email:  ______________________________

Referred By:  _____________________________ (New members – please list who referred you to MOWRA)

Membership in the Michigan Onsite Wastewater Recycling Association enrolls you as a constituent member of the National Onsite Wastewater Recycling Association.  Membership dues are for the calendar year.  Membership renewal invoices are sent out at the beginning of each calendar year.

                                    Membership Dues                                $85.00       Full member ($50.00 Regulator)

                                    MOWTEC Contribution                       _________ Help maintain the training site.

                                    (Optional - $25.00 suggested)

                                    Total Enclosed                          _________  Thank You

Please make checks payable to MOWRA and return to:

MOWRA, C/O Bill Gregory, 4300 Faussett Road, Howell, MI 48855

bill@wgsales.com                               (517) 546-3112