A retired or emeritus membership may be held by an individual who has been an active member of the NGWA Contractors,
Manufacturers, Suppliers, or Scientists and Engineers sections for a minimum of 20 years, is at least 65 years of age, and
who, as a result of retirement, disability, or other good cause, is no longer active in the groundwater industry.
To qualify for retired or emeritus status, please complete this application and return to NGWA at the address or fax number
at the bottom of this application, along with a scan of the front and back of your driver’s license.
Name ____________________________________________________________________ Birthdate _______/ _____/ _______
Retired from ____________________________________________________________________________________________
Home address ___________________________________________________________________________________________
City _______________________________________________ State/Province_______________________________________
Country ____________________________________________ Zip/Postal code ______________________________________
Daytime phone _______________________________________ Fax ______________________________________________
Email address ___________________________________________________________________________________________
Membership Application — Retired/Emeritus Status
NGWA occasionally makes members’ postal addresses available to vendor partners who supply products and services to the groundwater community. If you prefer
not to be included on these lists, please contact customer service at (800) 551-7379 or (614) 898-7791, or email firstname.lastname@example.org with your request.
Total membership fee $ ________
Verification of disability, if applicable (please check here and attach documentation).
I am a retired (check one): Contractor Manufacturer Supplier Scientist/Engineer
Contractor, Supplier, and Manufacturer retired membership includes a print subscription to Water Well Journal®, and digital
access to Groundwater® and Groundwater Monitoring & Remediation®.
Scientist and Engineer emeritus membership includes a print subscription to Groundwater Monitoring & Remediation and
digital access to Groundwater, Groundwater Monitoring & Remediation, and Water Well Journal.
Address 601 Dempsey Road, Westerville, Ohio 43081-8978 U.S.A.
Phone (800) 551-7379 • (614) 898-7791 Fax (614) 898-7786
Email email@example.com Websites NGWA.org and WellOwner.org