SEDA Membership Application

Yes, I want to join the Southeast Desalting Association to support the improvement of water supplies through desalting, reuse, and other water science.

CLICK HERE - for a printable version of this membership app.

CLICK HERE - for a printable version of member benifits..

Orginization:

Name:

Title:

Mailing Address:

City: State:

Zip Code:

Country:

Phone(999-999-9999):

Fax:(999-999-9999):

Cell Phone(999-999-9999):

Email:

Website:

SEDA Membership is based on an annual membership from January 1 - December 31 each year.
However, if application is received after Oct. 1, membership benefits shall extend to the end of the end of the following calendar year.

Membership Classification: Please select the appropriate membership category.

DIVISION I:
A.
Public Agencies, Industrial Users, and Water Suppliers
(includes 1 primary member and 5 additional 1B, 1C, or 3B members)
list additional members names, job titles, email addresses and other contact information:		 $195
 
1.
 Name: Title:
Phone: Email: 		 
 
2.
 Name: Title:
Phone: Email: 		 
 
3.
 Name: Title:
Phone: Email: 		 
 
4.
 Name: Title:
Phone: Email: 		 
 
5.
 Name: Title:
Phone: Email: 		 
 
B.
Certified Water Operator Individual Membership $25
 
State: Type:
Level: Cert #: 		 
 
C.
Certified Wastewater Operator Individual Membership $25
 
State: Type:
Level: Cert #: 		 

 

DIVISION II:
A.
Manufactures, Suppliers, and Consulting Firms $375
 
B.
Small Firms (Fewer than 5 employees) $195

 

DIVISION III:
A.
Individuals, Libraries, Well-wishers, Students $50
 
B.
Affiliate of Division 1A (Non-certified operator) $50
 
C.
Affiliate of Division 2A or 2B $50

 

Please indicate which committies you would be intrested in serving on:
Finance
Operator Certification
Legislative
Program
Membership
Public Relations
Newsletter
Technology Transfer

 

 I am intrested in running for a postion on the SEDA Board of Directors
I am intrested in presenting at a SEDA Symposium, Workshop, or MOC School

 

To pay, print out this page and mail it to the following address:

Payable to: Southeast Desalting Association, 2409 SE Dixie Hwy, Stuart, FL 34996

(Because of security concerns, we cannot accept credit card numbers over the internet)

Visa MC AMEX Check

Please Invoice PO#:

Credit Card#: ________________________________________

Expiration Date: ________/_________

(16 #'s + 3 #'s on back of card on signature pad of Visa/MC or + 4 #'s on front of AX)

Name on CC:______________________________________________________

CC Mailing Address:_____________________________________________________

CC Zip: _________________

Southeast Deslating Association (SEDA) - 2049 SE Dixie Hwy. - Stuart, Fl 34996
Phone: 772-781-7698 - Fax 772-463-0860 - admin@southeastdesalting.com - www.southeastdesalting.com