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: AWPCA Membership P.O. Box 830110 Birmingham, AL. 35283 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!