System Membership

For membership renewal, please complete the form below.

For questions, please contact Saem Yem at (573) 657-5533.

2019 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*
Correspondence (Other)
Please input title in space provided.
Number of Connections*
- 1-363 (Min. Membership Dues)
- 364-2545 (Variable Membership Dues)
- Over 2546 (Max. Membership Dues)
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: $200.00
Maximum Dues
Price: $1,400.00
# of Connections*
Price: $0.55 Quantity:
# of Connections*
Please enter/re-enter the exact number of system connections.
Phone*
FAX
Email*
Enter Email Confirm Email
Billing Address*
Street Address Address Line 2 City ZIP Code
Please read and check accordingly*
- Billing Address differs from Physical Address
Physical Address*
Street Address Address Line 2 City ZIP Code
Counties service is provided in:
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 credit card, please ensure that Billing Address matches the address associated with credit card.

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
To prevent additional charges to your credit card, X out of screen once form has been submitted.
Total
$0.00