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TBPA/ABPA MEMBERSHIP FORM TENNESSEE BACKFLOW PREVENTION ASSOCIATION AMERICAN BACKFLOW PREVENTION ASSOCIATION

NAME:	__________________________________________________________________
COMPANY:	__________________________________________________________________
ADDRESS:	__________________________________________________________________
CITY/STATE/ZIP:	__________________________________________________________________
PHONE:	__________________________________________________________________
FAX:	__________________________________________________________________
E-MAIL:	__________________________________________________________________
CHECK ONE:	RENEWAL: ______	(MEMBER # ______)
	NEW: ______
ABPA/TBPA TOTAL DUE $70.00
Make Check Payable to:			Tennessee Backflow Prevention Association
Send Completed Application and Check to:			Liba Ford Jackson Energy Authority P.O. Box 68 Jackson, TN 38302-0068

Membership includes bi-monthly ABPA Magazine and quarterly Tennessee Backflow News. Pre-payment of dues is required to process application. Membership is non-transferable. National ABPA membership required for state TBPA membership.