Qualification Form

Please fill out the following information and press the submit button to apply for a
free subscription to the Public Groundwater Systems Journal!

Free subscription to U.S./Canada residents only.

International residents can purchase a one-year subscription for $135 USD.

Check here if you want to receive Public Groundwater Systems Journal

*Select the category that best describes your work:

Operator of groundwater-supplied community water systems

a. Management
b. Operator
c. Other (please specify)

Contractors

x. Contractor who works on or with groundwater-supplied community water systems

Scientist or engineers

x. Scientist or engineer who works on or with groundwater-supplied community water systems

Suppliers

x. Supplier of equipment for groundwater-supplied community water systems

Manufacturers

x. Manufacturer of equipment for groundwater-supplied community water systems

Name*

Title*

Company*

Address 1*

Address 2

City*

State/Province*

Zip/Postal code*

Country*

Phone

Fax

E-mail

Web site

Comments

*You must enter your month of birth as an electronic verification
that you have filled out this qualification form.

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Please allow four to six weeks to process your application.
Due to the volume of requests we receive, we cannot reply individually to every denied request.
If your application is approved, you will receive your first issue in four to six weeks.

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