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PRE-REGISTRATION REQUIRED FOR ...
YOU MUST PRE-REGISTER IF YOU ARE TAKING EXAMS AT
VERMONT DRILLING DEMONSTRATION ...
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  The ESWWDA is interested in men and women who desire a career in the field of ground water resources  
 
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About Us
  To apply for a ESWWDA membership you can either fill this form out and click the 'submit' button at the bottom of this page, or you can print this form and mail it with payment to:

Sue Bates
ESWWDA
900 North James Street
Rome, NY 13440

*Please be sure to include a check made out to ESWWDA if you mail in your application.
* denotes required fields     
  

* Company Name:

* Contact person:

* Address

* City:
   

* State:

* Zip:

* Phone:

Fax:

Email:

Years in business:

Number of machines:

NYRD #

N.G.W.A. Certification and number

Below list Branch Locations and the
Counties you Service in New York

Service and products offered: Select all that apply.
 
 

Contracter/Driller/Pump Installer
(Hold down your Ctrl key to select more than one)
 

Your Web Address (if any):
Manufacturer / Supplier  
(Hold down your Ctrl key to select more than one)
 


Membership Classification: (please check one)

 Contractor/Driller  $125.00   Pump Installer   $125.00
Manufacturer/Supplier   $125.00
Associate Member   $25.00
(Associate Members can only be employees of companies who have full memberships)

Enter any additional information or comments below:
 
 
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