Florida Section American Water Works



Florida Section AWWA | 1300 Ninth Street | Suite B-124 | St. Cloud, FL 34769

Phone: 407-957-8448 | Fax: 407-957-8415 | Email: peggy@

|Name: |      |Title: |      |

|Name of agency, government, utility or organization you represent: |

|      |

|Address: |      |

|City/County/State: |      |Zip: |      |

|Area Code/Phone No.: |      |Area Code/Fax No: |      |

|Email Address: |      |Website Address: |      |

|I am a member of AWWA: |The agency I represent is an AWWA member: |

| Yes No | Yes No |

| |

|Areas of Interest: Select areas of interest (up to 5) by entering numbers 1 through 5 in the selected |

|boxes to indicate your level of interest (1 = most interested; 5 = least interested). |

|State Level (Councils): |

|Administrative Council: |Technical & Education Council: |Manufacturers/Associates Council: |

|Landmark Awards |Water Quality & Resources |New Technology Showcase |

|Membership |Water Use Efficiency |Water Distribution System Awards |

|Scholarships |Distribution System |Fall Conference |

|Charities (Water for People) |Research |Operator Competitions |

| | |Golf Tournament |

| | |Exhibits |

| | |Technical Program |

|Public Affairs Council: |Utility Council: | |

|Customer Service |Membership | |

|Government Affairs |Legislative | |

|Youth & Education Outreach |Regulatory Policy | |

| |Operators and Maintenance Council: |Contractors Council: |

| |Scholarship |Membership Development |

| |Top Ops |General |

|State Level (Committees): |Regional/Local Level: |

| Certification & Training Board | Contractors Council | Safety |

|Finance |Manufacturers/Associates Council |Awards |

|Florida 2030 |Operators and Maintenance Council |Administrative |

|Marketing |Public Affairs Council |Young Professionals |

|Young Professionals |Technical & Education Council |University Student Chapters |

| |Utility Council/Legislative |Water Conservation |

| |Model Water Tower Competition |Youth Education |

| |Membership |Charities (Water for People) |

| |Newsletter |Other: |

| |Media Relations |      |

|Personal Information: |Birthday (Month/day): |      |

|Years Worked in Water Industry: |      |FSAWWA Member Since: |      |

|Committees/Agencies Served on: |      |

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|Suggestions, Ideas and Comments Welcomed: |      |

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|Email completed form to: peggy@ |

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