Member

Thank you for your interest in joining the New Mexico Ground Water Association, please complete the fields below. If you have employee members to enroll, you will be able to do this after we send you your Member Information Center login credentials. If you have previously been a member or have attended events as a non-member you are already in our system, please do not submit a new application, call Robin at 505-867-9500 to set up your membership.

Business Information

Company Name: *

Leave Blank:

Phone: *

Website:

Email: *

Business Description (200 char max):

Employees:

Full-time Part-time

Comments / Questions:

Physical Address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Mailing Address

Same as physical address

Line 1: *

Line 2:

City: *

State: *

Postal Code: *

Country: *

Primary Contact Information

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Social Networking:

LinkedIn Facebook

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Billing Contact Information

Same as Primary Contact

First Name: *

Last Name: *

Title:

Phone: *

Cell Phone:

Fax:

Email: *

Contact Preference:

Email Phone

Social Networking:

LinkedIn Facebook

Address

Same as Member Address

Line 1: *

Line 2

City: *

State: *

Postal Code: *

Country: *

Membership Options

Membership Package: *

Contractor : $150.00
Any person, firm or corporation engaged in a well drilling, pump and well repair, or a pump installation business Manufacturer: $150.00
Any person, firm or corporation engaged in the manufacturing of equipment or materials used in the ground water industry. Supplier: $150.00
Any person, firm or corporation engaged in the sale of equipment to contractors involved in then ground water industry. Technical: $150.00
Any Hydrologist, Geologist or Engineer involved in consulting, teaching, research or government services.

Payment Option:

Charge my credit or debit card

Print Application

New Mexico Ground Water Association

Member Application

Mailing Address

Address

Address