Virginia Rural Water Association
2138 Sycamore Avenue
Buena Vista, VA  24416
540-261-7178
FAX: 540-261-2465

Please complete & Mail or Fax the following to us so that we may update our records!
VRWA Mailing List Information

Name of Person to be Added to Mailing List: _____________________________________________

Name of System or Corporation: _______________________________________________________

Mailing Address: ___________________________________________________________________

_________________________________________________________________________________

Telephone Number: _________________________________________________________________

Fax Number: _____________________________________________________________________

E-Mail Address of Contact: ___________________________________________________________

Date Submitted: ____________________________________________________________________