Qualification Form

Please fill out the following information and press the submit button to apply for a
free subscription to the Water Well Journal®!

This form is only for individuals who are NOT NGWA members.

Those not directly working in the groundwater industry can purchase a one-year subscription. The fee for those in the United States is $105 and $120 for those in Canada. A subscription for all other international residents is $140. Click on http://waterwelljournal.org/2011/06/423/ for more information. (Funds listed in USD.)

Check here if you want to receive Water Well Journal.

*Select the category that best describes your work:

Contractor

a. Full-service contractor
b. Pump-only contractor
c. Drilling-only contractor
d. Monitoring contractor
e. Water treatment installer
t. Irrigation
s. Student (enter area of study)
o. Other water well contractor

Supplier

a. Supplier, full-service groundwater
b. Supplier of some groundwater lines
c. Management services
t. Irrigation
o. Supplier, other

Manufacturer

a. Management
b. Sales personnel
c. Manufacturers' representative
d. Company employee
t. Irrigation
o. Other (please specify)

Operator of groundwater-supplied community water systems

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

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.

*Indicates a required field.

Please only click on the submit button once; it may take a few seconds to submit the file.
A new page will open when your form has been successfully submitted.

For security reasons, please enter the code shown in the box below.
Security code:
Enter code:

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.