Local Affiliate Renewal -  2017

Thanks for your support of the East Michigan Chapter of A&WMA. 
First Name 
Last Name 
Affiliation/Company 
Industry
Government
Consultant
Lawyer
Commercial
Non-Profit Organization
University Staff
Full-Time Student 
Other,  type:  
Address  / Opt. Addr. Info:
City/State/ZIP 
E-mail 
Phone  xxx.xxx.xxxx
Major Interests
Air Sustainability
Waste Water
Assist with Committees
Scholarship
Science Fair
Programs
Education
Newsletter
Student Chapters
Membership
Affiliate Type
Regular - $15 Half Year
Student - $5 Half Year
Optional Tax-deductable Donation - ($10 min. please)
Payment Options 
    To:  East Michigan Chapter A&WMA
           PO Box 725162
           Berkley, Michigan 48072  
    Check Memo: 2017 Affiliation Fee
 -- OR --
    Credit Card or Direct Withdrawal

(You will get an e-mail confirmation of this payment)

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