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* 1. Are you an associate member of Connecticut Rural Water & Wastewater Association (formerly known as Atlantic States Rural Water and Wastewater Association)?

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* 2. Contact Name

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* 3. Company/Organization Name

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* 4. email address

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* 5. Street address #1

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* 6. Street address #2

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* 7. City

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* 8. State

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* 9. Zipcode

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* 10. Phone Number

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* 11. Do you give CTRWWA permission to send you newsletters, emails, and other communications?

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