Local Affiliate Renewal - 2025

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 - $30 Full Year
	Student - $10 Full Year
	Optional Tax-deductable Donation - ($10 min. please)

Payment Options

To: East Michigan Chapter A&WMA
PO Box 725162
Berkley, Michigan 48072
Check Memo: 2025 Affiliation Fee

-- OR --

Credit Card or Direct Withdrawal

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