IGWA.org - IGWA Membership Application

Application Type (Check One):
Dues are based on the Calendar Year (Jan 1 - Dec 31)

	MEMBER - Dues $30 per year Professional, scientific, technical, or legal interest in groundwater; may vote or hold office; receives newsletter; reduced meeting rates.
	SUBSCRIBER - Dues $20 per year Receives newsletter only; may not vote or hold office; pays non-member rates for meetings
	STUDENT - Dues $10 per year Students in scientific, technical, or legal groundwater studies; must apply yearly for this class of membership; receives newsletter; student rate for meetings.
	CORPORATE - Dues $200 per year Corporations which have a scientific, technical, or legal interest in groundwater resources may apply. Corporate members receive two copies of the newsletter, the Iowa Groundwater Association Quarterly, and may display a business card in this publication at no charge. A listing of designated corporate employees must be submitted annually. Designated employees receive reduce meeting rates but may not vote or hold office.

All Applicants Must Complete the Following:

Name:

Employer:

Daytime/Work Telephone:

Home Telephone:

Fax:

E-mail:

Title or Job Description:

Mailing/Work Address:

City:

State:

Zip:

Home Address:

City:

State:

Zip:

	From time to time, other organizations with an interest in groundwater will request our mailing list and/or the IGWA Membership Directory. If you do NOT want your name on the mailing list we provide, or if you do not wish to have your membership information (except name) listed in the Membership Directory, please indicate by checking this box.
	IGWA also publishes is membership directory on its web site at IGWA.org. If you do not wish to have your membership information listed in the Online Membership Directory, please indicate by checking this box.

Additional Information for the
IGWA Membership Directory (optional)

The IGWA develops a yearly Membership Directory. The Directory will contain
the information you have provided on the application, as well as any additional
information you list below (unless you have checked the box above).

Provide any professional certifications, accreditation, or registrations
you currently possess:

Provide your special interests or your area of expertise.

Student Applicants Must Complete the Following:

Department:

Institution:

Dept. Chair (or Major Professor)

Department Telephone:

Corporate Applicants Must Complete the Following:

Designated Employee	Daytime Telephone Number










If you need to list additional people, please e-mail them to igwa@mchsi.com.

Do you wish to submit a business card for the Iowa Groundwater Quarterly?
Yes No
If yes, please mail the business card to the address below.

After filling out this application, please print it,
and submit application and all applicable dues to:

Iowa Groundwater Association
1819 High Street
Iowa City, Iowa 52245

Please direct any questions to
igwa@mchsi.com