Membership Application

If you would like to join NvWARN, please fill out the form below. Someone will contact you in five to 10 business days. If you have a question or comments, please fill out our general NvWARN Contact Form.

* Required Fields

Agency Information

*Agency Name

*Agency Type

Choose One Water Wastewater Water and Wastewater

*Agency Address

*County

*City

*State

AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

*Zip

*Agency Main Phone

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24-Hour Contact Phone

( ) -

*Membership Type

Utility Membership
Associate Membership What is this?

Water System Information

Public Water System Number

Wastewater Permit Number

Number of Water Connnections

Water Population

Primary Contact

*First Name

*Last Name

*Title

*Phone

( ) -

Cell Phone

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*Email

*Confirm Email

Secondary Contact

*First Name

*Last Name

*Title

*Phone

( ) -

Cell Phone

( ) -

*Email

*Confirm Email