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

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* 2. Name of Utility

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* 3. # of population served

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* 4. Contact Name

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* 5. email address

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* 6. Street address #1

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* 7. Street address #2

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* 8. City

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* 9. State

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* 10. Zipcode

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* 11. Phone Number

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

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