Membership Application

Membership Types

Individual Member - $90
Company/Agency Member (3 Memberships included) - $250 per company/agency, then $60 per additional employee after 3
Student Member - $20

*Select Type:

Individual Member
Company/Agency Member	- Qty:
Student Member

Prefix:

*First Name:

*Last Name:

Suffix:

*Company/Agency Name:

Address:

Address 2:

City:

State:

Zip:

Country:

*Email:

Phone:

FAX:

Website:

Username:

Password:

Code Of Ethics:

Click here to indicate that you have read and agree to the CPOW Code of Ethics.
Click to Read

NewsLetter:

Click here if you do not wish to receive CPOW enewsletter and notifications.

Sector:

Choose one classification from BOTH CPOW and NOWRA Lists.

Membership Classification:

Scholarship Donation:

$
If you would also like to make a scholarship donation, please enter the amount here. Thank you!

*Payment Method:

Credit Card:

	*Credit Card Type:	Discover MasterCard VISA
	*CC Number:
	*CC Exp Mo/Yr:	/
	*CC Security Code:

Company/Agency Coupon Code:

*Code:

Check:

Remember that you must send a check as payment to:
CPOW
PO Box 918
Strasburg, CO 80136

Please review and verify the above information, then:

Colorado Professionals in Onsite Wastewater • PO Box 918 • Strasburg, CO 80136 • (720) 626-8989 • cpow@cpow.net
Participation as a member of CPOW is not an endorsement by CPOW of a company/individual or their products and services.