System

To apply/renew membership online using debit/credit, use the form below.

2022 System Membership Form

• System Name*
• Please indicate the individual who should receive correspondence. Your assistance in providing the following information will make it easier for the Association staff to meet your system's needs.
• Correspondence*
  Please choose your role/title from the drop-down list below:
  Board President/MayorWater/Wastewater Superintendent/ManagerPublic Works DirectorOffice ManagerClerkOther
• Correspondence (Other)
  Please input your role/title in the space provided.
• Number of Service Connections*
  Choose the appropriate selection from below.
  • 0-413 Connections
  • 414 -2413 Connections
  • 2414 Plus Connections
• Membership dues in Missouri Rural Water Association are not deductible as charitable contributions for federal income tax purposes. However, they may be deductible as professional or business expenses, to the extent allowable by law.
• Minimum Dues
  Price:
• # of Connections*
  Input the number of service connections ranging from 414 to 2413.
  Price: $0.58 Quantity:
• Maximum Dues
  Price:
• # of Connections*
  Please re-enter the exact number of service connections.
• Phone*
• FAX
• Email*
  Enter Email Confirm Email
• Billing Address*
  Please use the address associated with Debit/Credit card.
  Street Address Address Line 2 City ZIP Code
• Please check accordingly*
  • Billing Address differs from Physical Address
  • Same
• Physical Address*
  Street Address Address Line 2 City ZIP Code
• Counties Served*
  Please list the names of the counties served by your system.
• Board President or Mayor*
  First Last
• Board President/Mayor Address
  Please check this box if Board President/Mayor receives correspondence at a different address.
  • Board President/Mayor Correspondence Address
• Board President/Mayor Correspondence*
  Street Address Address Line 2 City ZIP Code
• Water Superintendent/Manager*
  First Last
• Certification Level
  (Example: DS-II, DW-C)
• Clerk/Office Manager*
  First Last
• Certification Level (if applicable)
  (Example: DS-II, DW-C)
• Please list all certified operators and their certification levels below.
• DS-Distribution
• DW-Water Treatment
• WW-Wastewater Treatment
• Certified Operators*
  To add names, click the (+) sign to the right of the row.

  First Name	Last Name	Certification Level

• Credit Card
  Note: When paying by debit/credit card, please ensure that Billing Address matches the address associated with card.
  American Express

  Discover

  MasterCard

  Visa

  Supported Credit Cards: American Express, Discover, MasterCard, Visa

  Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date   Security Code Cardholder Name
• To prevent additional charges to your card, X out of screen once form has been submitted.
• Total
  $0.00
• Email
  This field is for validation purposes and should be left unchanged.