South Carolina Rural Water Association

2011 System Membership Form

System Information:

System Name

System Address

City

Phone

Fax

Website

# Water Taps

# Wastewater Taps

Contact Information:

Manager/Director Email

Office Manager/Clerk Email

Mayor/Board Chair Email

Water Operator Email

2011 Membership Rates/Order Form:

Please enter the quantity of memberships you are purchasing

1 – 50 Taps: $200

51 – 500 Taps: $250

501 – 2,500 Taps: $300

2,501 – 5,000 Taps: $350

5,000 - 9,999 Taps: $500

10,000+ Taps: $600

Donations

Please enter the amount of your donation

Contribute to the SCRWA Building Fund, which will fund an office complex for the association and a training center.
Support the SCRWA Legislative Efforts, which monitores the industry legislation and provedes a collective voice for SC utilities.
Support SCRWA's Public & Education Outreach programs. These donations will be used in arious areas to promate the value of our industry throughout South Carolina.

SCRWA Publications:

Additional Mailings can be sent to your personnel or Board Members for $15 each.
Please provide name(s) and address(s) (if different) below.