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Membership Application

If you would like to join NvWARN, please fill out the form below. Someone will contact you in 5 to 10 business days. If you have a question or comments, please fill out our general NvWARN Contact Form.

Contact Information

First Name

Last Name

Job Title

Phone

( ) -

Cell Phone

( ) - (Optional)

E-mail

Confirm E-mail

Agency Information

Agency Name

What if I don't find my agency's name?

Agency Type

Agency Address

County

City

State

Zip

Agency Main Phone

( ) -

24-Hour Contact Phone

( ) - (Optional)

Membership Type

Utility Membership
Associate Membership What is this?

Water System Information

Public Water System Number

(Optional)

Wastewater Permit Number

(Optional)

Number of Water Connnections

(Optional)

Water Population

(Optional)

Please verify: