Nevada Rural Water Association

Membership Application and Dues Structure

Please print the following form and complete ALL THAT APPLIES TO YOU and return to NVRWA: 363 Fairview Drive, Carson City, Nevada 89701 OR Fax to: 775-841-4243.

Any questions, please call 775-841-4222                

NvRWA is an equal opportunity provider and employer.

Date:                                           System, Company or Individual Name:
Contact Person:
Mailing Address:
City & County: State & Zip:
Physical Address (if different):
City & County: State & Zip:
Ph: Fax: Email:
Associate Members, Primary Business: Web Site:
System Operator(s):  

NVRWA Annual Dues Structure
Please check next to the appropriate section.

Number of Connections Rates:
1 - 50 $100.00
51 - 3,300 $210.00
Support Membership* (serving a population >10,000) $225.00
Associate Membership* $220.00
Individual Membership (not available to companies) $50.00
Donation to Water PAC (National Rural Water lobbying efforts) $
Billing
Please Invoice Us  Dues $__________________  Donation $ __________________
Check is Enclosed  Dues $__________________  Donation $ __________________

*NOTE: Your dues and/or donations may or may not be tax deductible. Please contact your tax advisor.

The following information is requested by the Federal Government in order to monitor compliance with Federal Laws prohibiting discrimination against applicants seeking to participate in this program. You are not required to furnish this information, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way.  However, if you choose not to furnish it, we are required to note the race/national origin of individual applicants on the basis of visual observation or surname.  

Applicant: ___I do not wish to furnish this information                      

Co-Applicant: ___I do not wish to furnish this information

Ethnicity: ____Hispanic or Latino ___ Not Hispanic or Latino

Ethnicity: ____Hispanic or Latino ___ Not Hispanic or Latino

 Race: ____American Indian or Alaska Native       ____Asian               ____Black  or  African American  ____Native Hawaiian or Other Pacific Islander           ____White                                          P     

  Race: ____American Indian or Alaska Native       ____Asian               ____Black  or  African American  ____Native Hawaiian or Other Pacific Islander           ____White

Sex: _____ Female                  _____ Male

Sex: _____Female                   _____Male