Sam Houston Water Utilities Association
Membership Form
Please copy the form below and send with a check or money order to:
Texas Water Utilities Association
Individual Membership Application and Address Change Form
USE THIS FORM TO:
1.) Join T.W.U.A. “At-Large” 2.) Join T.W.U.A. and the District/Chapter you desire 3.) Renew your membership 4.) Change an address
CHECK ONE: Active Member _____ Full-Time Student _____ T.W.U.A. Honorary _____
CHECK ONE: Membership Renewal _____ New Member _____ Address Change Only _____
District or Chapter ___SAM HOUSTON WATER UTILITY ASSOCIATION _______ Membership for year 20_____
Name _________________________________________________________________________________________
SS# __________-__________-__________ Water or Waste Water License No. _________________________
Home Address __________________________________________________________________________________ City _______________________________________________ State _______________ Zip ___________________
E-Mail ________________________________________________________________________________________
Home Phone: _________________________________ Work Phone: ______________________________________
If address change only, list old address: _______________________________________________________________
Employer ______________________________________________________________________________________
Name and Address
Job Title _______________________________________________________________________________________
Amount of dues pd. (If applicable) ____________________________________________________________________________
Signature of member__________________________________________________________ Date _________________________
Signature of Secretary ________________________________________________________ Date _________________________
$5.00 OF YOUR T.W.U.A. DUES IS ALLOCATED
FOR A SUBSCRIPTION TO THE TEXAS WATER UTILITIES JOURNAL.