NBMA - Membership Registration Form

Membership Registration

NBMA Annual Membership Dues Structure
The NBMA dues structure is based on two membership categories: member and subscriber.

Members are qualified public and tribal wastewater treatment agencies in Washington, Oregon, Idaho, Alaska and British Columbia with existing or future biosolids management responsibilities. Members pay flat annual membership dues; an additional production share is based on the individual agency's biosolids production rate. Members are granted voting privileges in the Association and may serve on the Board of Directors.

Subscribers are any non-public organizations, such as engineering firms and biosolids management companies, that wish to participate in the NBMA. Subscribers pay flat annual membership dues based on the number of company employees. Subscribers are entitled to all rights of membership except voting rights. They may serve on committees and as ex-officio members of the Board of Directors.

Dues:

Member Agency Dues	Subscriber Dues
A flat fee of $77	A flat fee of:
+ production share	$231 for 5 or less employees
	$462 for 6-15 employees
	$1156 for more than 15 employees

Registration Form

Yes! I would like to register for membership in the NBMA. Upon receipt of this form, I will be billed for an amount based on the policy above and the information I provide below. By filling out and submitting this form, I agree to comply with the NBMA's policy of promoting biosolids recycling. Please consider my agency/company for the following membership category:

Member Subscriber
Main Contact Position
Additional Contact(s) for Mailing List (if at a different address, please list in Additional Comments)
Name Position
Name Position
Name Position
Agency/Company Name
Address
City
State/Province	Zip/Postal Code
Phone	Fax
E-mail Address
Website URL

General Information
This new member is a:	Agency Private Company

Wastewater Treatment Agency (Please list any additional facts about your facility in Additional Comments)
1. Facility's treatment capacity:	mgd
2. Service population:
3. Wastewater source(s):	Industrial % Domestic % Storm %
4. Facility produces	tons of dry solids per year (dry tons/year)
5. Type of wastewater treatment (check all that apply):	Primary Secondary Tertiary Other	Activated sludge Trickling filter Oxidation Lagoon Other
6.Type of biosolids treatment:	Aerobic Anaerobic Other
7. Indicate the type of biosolids thickening/concentration equipment you have at your facility (check all that apply):	Gravity Thickener Gravity Belt Thickener Belt Press Centrifuge Drying Bed Other (specify)
8. Does your plant accept septage?	Yes No
9. What is the ultimate destination of your biosolids? (indicate percentage of each)
Agriculture	Forest Application
Lagoon	Compost
Incineration	Landfill Disposal
Land Reclamation	Landfill Cover
Other (specify)
Private Company
Number of employees:
10. What services do you provide? (You may send up to one page of camera-ready, pertinent information about your company to the NBMA office for inclusion in the NBMA's Annual Report.)

Any Additional Comments

If you prefer a hard copy, or have additional information to supply about your agency/company, please contact:

Northwest Biosolids Management Association
201 S. Jackson St., KSC-NR-0512
Seattle, WA 98104-3855, USA

Phone: (206) 684-1145
Fax: (206) 263-3485
Email: denise.vieira@nwbiosolids.org