North Dakota Rural Water Systems Association - Rural Water System Registration/Renewals

Rural Water System Information

Member/System Name^*

Mailing Address^*

City^*

State^*

ZIP^*

Phone Number^*

Website Address^*

Email Address^*

Rural Water System Contacts

Manager

Manager First Name

Manager Last Name

Manager Email

Manager Vacant / NA

Office Manager

Office Manager First Name

Office Manager Last Name

Office Manager Email

Office Manager Vacant / NA

Operator 1

Operator 1 First Name

Operator 1 Last Name

Operator 1 Email

Operator 1 Vacant / NA

Operator 2

Operator 2 First Name

Operator 2 Last Name

Operator 2 Email

Operator 2 Vacant / NA

Operator 3

Operator 3 First Name

Operator 3 Last Name

Operator 3 Email

Operator 3 Vacant / NA

Operator 4

Operator 4 First Name

Operator 4 Last Name

Operator 4 Email

Operator 4 Vacant / NA

Employees

Employee 1

Employee 1 First Name

Employee 1 Last Name

Employee 1 Email

Employee 2

Employee 2 First Name

Employee 2 Last Name

Employee 2 Email

Employee 3

Employee 3 First Name

Employee 3 Last Name

Employee 3 Email

Employee 4

Employee 4 First Name

Employee 4 Last Name

Employee 4 Email

Employee 5

Employee 5 First Name

Employee 5 Last Name

Employee 5 Email

Employee 6

Employee 6 First Name

Employee 6 Last Name

Employee 6 Email

Board of Directors

President

President First Name

President Last Name

President Vacant / NA

President Address

President City

President State

President ZIP

President Phone

President Email

Vice President

Vice President First Name

Vice President Last Name

Vice President Vacant / NA

Vice President Address

Vice President City

Vice President State

Vice President ZIP

Vice President Phone

Vice President Email

Secretary

Secretary First Name

Secretary Last Name

Secretary Vacant / NA

Secretary Address

Secretary City

Secretary State

Secretary ZIP

Secretary Phone

Secretary Email

Treasurer

Treasurer First Name

Treasurer Last Name

Treasurer Vacant / NA

Treasurer Address

Treasurer City

Treasurer State

Treasurer ZIP

Treasurer Phone

Treasurer Email

Director 1

Director First Name

Director Last Name

Director Vacant / NA

Director Address

Director City

Director State

Director ZIP

Director Phone

Director Email

Director 2

Director 2 First Name

Director 2 Last Name

Director 2 Vacant / NA

Director 2 Address

Director 2 City

Director 2 State

Director 2 ZIP

Director 2 Phone

Director 2 Email

Director 3

Director 3 First Name

Director 3 Last Name

Director 3 Vacant / NA

Director 3 Address

Director 3 City

Director 3 State

Director 3 ZIP

Director 3 Phone

Director 3 Email

Director 4

Director 4 First Name

Director 4 Last Name

Director 4 Vacant / NA

Director 4 Address

Director 4 City

Director 4 State

Director 4 ZIP

Director 4 Phone

Director 4 Email

Director 5

Director 5 First Name

Director 5 Last Name

Director 5 Address

Director 5 City

Director 5 State

Director 5 ZIP

Director 5 Phone

Director 5 Email

Other Information

Number of Users

Annual Water Usage

Minimum Cost

Minimum Gallons

Dollar per Gallon

Miles of Pipe

Cities Served

Annual Meeting Date

Monthly Board Meeting Date

We are modifying our dues schedule; therefore, a second dues notice for one year (July 2021 to June 2022) will be sent mid-year.

Equipment Purchase/Maintenance Donation

Patrick Denne Memorial Scholarship Donation