This is for new Group B applicants only. If you wish to apply for any other type of membership, please use the standard membership application found here.

Fill in the form below to submit your application. If you have any questions please contact us at treasurer@whidbeywatersystems.org.

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Application Type *

• New Application for Membership

Water System Name *

Number of Active Connections *

Designated Representative *

First

Last

Mailing Address (Street or PO Box, Town, City & Zip Code) *

Phone Number *

Email *

Alternate Representative

First

Last

Email

Dues *

• $25 – Group B System with 2-14 active connections

Submitted by: *

First

Last

Title *

Submit Application