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

Please complete the following & fax or mail to VRWA so that we may update our records!
VRWA Member Update

Name of System or Corporation: _____________________________________________________

Contact Person (VRWA Voting Delegate): _____________________________________________

Alternate Contact: ________________________________________________________________

Number of Connections: _________________________   Water Source: ______________________

Are you metered? ____________________      Do you have full-time operators? _________________

Are the operators certified? _________________          Congressional District:___________________

Population: _____________  E-Mail Address of Contact:___________________________________

Telephone Number: ____________________________  Fax Number: ________________________

Mailing Address: __________________________________________________________________

_______________________________________________________________________________

Signature of Voting Member Submitting Update: _________________________________________

Date Submitted: __________________________________________________________________