Florida Ground Water Association Membership Application

Membership Application

Company Information

Name of Firm *

Mailing Address *

City *	State *	ZipCode *


Phone *	FAX	Email *


DEP License Number *	Number of Employees *	Website

Please select appropriate classification and remit accordingly

Contractors Division

Any person, partnership, company, or corporation who contracts with a purchase for well-drilling or pump and equipment installation.

Type	Member(s)	Cost
Contractor Individual (one voting membership)
Contractor Corporate (three voting memberships)

Ground Water Technology Division

Any person, partnership, company, corporation, institution, or agency engaged in the supervision, regulation, evaluation, development, or investigation of underground waters or ground water supply installation or related technology or any individual in an accredited university, college, or preparatory school, public or private, studying or teaching subject matter embracing the water well industry.

Type	Member(s)	Cost
Ground Water Technology Individual (one voting membership)
Ground Water Technology Corporate (three voting memberships)

Associate Member

Any person, partnership, company, or corporation engaged in providing equipment, supplies, materials, or services used in the water well industry.

Type	Member(s)	Cost
Associate Member Individual (one voting membership)
Associate Member Corporate (three voting memberships)

Supporting Member

Any individual who is an employee of a member firm. This membership includes right of voice, but not the right to hold office or vote

	Sponsored By			Cost
Supporting Member

Payment

Total

Pay by Credit Card

First Name on Card *	Last Name on Card *	Billing Postal Code *


Billing Street Address *

Credit Card Type	Credit Card Number *	CVV2 *	Expiration *

Pay by Check

If paying by check or money order, please make it payable to FGWA. Mail it to the address below, including a copy of your application that will be emailed to you after you submit this form.

325 John Knox Rd
Suite L103
Tallahassee, FL 32303