CTWEA Membership

Name of Person Completing this form

First Last

Email of person completing this form

Company Name (Employer)

Mailing Address*

Street Address City State / Province / Region ZIP / Postal Code

Address Type*

Home Address

Business Address

Phone Number*

Name of 1st Person to Receive Membership Benefits*

First Last

Email*

Membership Options*

Memberships are good for one year based on your anniversary join date. For membership benefits click here Renewals notices will be sent out one month prior to your lapse date.

Individual Member ($20/yr per individual) - Individuals employed by a municipality, city/town or regulator within the State of CT.

Associate Member ($100/yr per individual) - Individuals who are interested in “furthering the purposes” of the CTWEA. Consulting engineers, vendors and other professionals are eligible.

Student Membership (Free) - Students enrolled in an accredited college or university. A valid student ID is required.

Would you like to add a 2nd Membership?*

Name of 2nd Person to Receive Membership Benefits*

First Last

Email*

Membership Options*

Memberships are good for one year based on your anniversary join date. For membership benefits click here Renewals notices will be sent out two months prior to your lapse date.

Individual Member ($20/yr per individual) - Individuals employed by a municipality, city/town or regulator within the State of CT.

Associate Member ($100/yr per individual) - Individuals who are interested in “furthering the purposes” of the CTWEA. Consulting engineers, vendors and other professionals are eligible.

Student Membership (Free) - Students enrolled in an accredited college or university. A valid student ID is required.

Would you like to add a 3rd Membership?*

Name of 3rd Person to Receive Membership Benefits*

First Last

Email*

Membership Options*

Memberships are good for one year based on your anniversary join date. For membership benefits click here Renewals notices will be sent out two months prior to your lapse date.

Individual Member ($20/yr per individual) - Individuals employed by a municipality, city/town or regulator within the State of CT.

Associate Member ($100/yr per individual) - Individuals who are interested in “furthering the purposes” of the CTWEA. Consulting engineers, vendors and other professionals are eligible.

Student Membership (Free) - Students enrolled in an accredited college or university. A valid student ID is required.

Would you like to add a 4th Membership?*

Name of 4th Person to Receive Membership Benefits*

First Last

Email*

Membership Options*

Memberships are good for one year based on your anniversary join date. For membership benefits click here Renewals notices will be sent out two months prior to your lapse date.

Individual Member ($20/yr per individual) - Individuals employed by a municipality, city/town or regulator within the State of CT.

Associate Member ($100/yr per individual) - Individuals who are interested in “furthering the purposes” of the CTWEA. Consulting engineers, vendors and other professionals are eligible.

Student Membership (Free) - Students enrolled in an accredited college or university. A valid student ID is required.

Would you like to add a 5th Membership?*

Name of 5th Person to Receive Membership Benefits*

First Last

Email*

Membership Options*

Memberships are good for one year based on your anniversary join date. For membership benefits click here Renewals notices will be sent out two months prior to your lapse date.

Individual Member ($20/yr per individual) - Individuals employed by a municipality, city/town or regulator within the State of CT.

Associate Member ($100/yr per individual) - Individuals who are interested in “furthering the purposes” of the CTWEA. Consulting engineers, vendors and other professionals are eligible.

Student Membership (Free) - Students enrolled in an accredited college or university. A valid student ID is required.

Total

Payment Method*

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Checks must be made out to CTWEA. Please send to: CTWEA 10 Tower Office Park, Suite 601 Woburn, MA 01801 Questions please contact info.ctwea@gmail.com

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