Application for Utilitiy ACWUA Membership

Fields marked with a red asterisk are mandatory!

Nominated Representative

Title*

Mr.

Mrs.

Academic title/Degree

First name*

Last name*

Position

Department

Please send me documentation from ACWUA for information purposes.

Yes

Company Data

Company/Authority/Organisation*

Company line 2

Address*

Address line 2

Address line 3

Address line 4

Address line 5

P.O. box

ZIP

City*

Country

Contact Data

Phone*

Phone 2

Phone 3

Fax

E-mail*

E-Mail 2

Internet

Utility Specification

Population size band

Annual water sales

Form of utility*