ALABAMA WATER POLLUTION CONTROL ASSOCIATION
INDIVIDUAL MEMBERSHIP APPLICATION

INDIVIDUAL INFORMATION:
Name:____________________________
Home Mailing Address(required):___________________________________
City:________________ County:___________________ State:_____ Zip:_______
Home Phone #:_______________________
Work Phone#:______________________
Email Address (required):___________________________
Job Title:__________________________

PLEASE CIRCLE YOUR CERTIFICATION GRADE:
WATER: I II III IV - WASTEWATER: I II III IV

EMPLOYER INFORMATION:
Employer:___________________________________________________________
Employer Address:____________________________________________________
Facility Name:_______________________________________________________
City:________________ County:___________________ State:_____ Zip:_______

METHOD OF PAYMENT:
Enclosed is: Check_____ Money Order_____ Cash_____ in the amount of $35.00
(Please make checks or money orders payable to AWPCA)

Signature of Applicant:_________________________________________________


AWPCA MEMBERSHIP

Be sure to fill in your home mailing address. This will insure you receive all special mailings and fliers that are sent out periodically. You can print out this page, fill it out and return the completed membership application along with your check or a money order made payable to "AWPCA" to:

Jarrod Shotts
Treasurer
P.O. Box 830110
Birmingham, AL. 35283
Work: (205)244-4372,
Fax: (205)244-4872

MEMBERSHIP DUES - are due on or before June 1st each year.
Unpaid dues are in arrears September 15th of each year.

To pay dues online click here!