Qualification Form

Please fill out the following information and press the submit button to apply for a free subscription to the Water Well Journal®!
Free subscriptions to U.S./Canada residents only.
This form is only for individuals who are NOT NGWA members.
International residents can purchase a one-year subscription for $125 USD.
Click on http://www.ngwa.org for more information.

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 ground water
b. Supplier of some ground water 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 ground water-supplied community water systems
a. Management
b. Operator
c. Other (please specify)
*Name
*Title
*Company
*Address 1
Address 2
*City
*State
*Zip/postal code
*Country
Phone
Fax
E-mail
Web site
Comments

*You must enter your year 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 provided before clicking submit.
Security Code: NGWA08

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.