WASAMA Membership Application Form

Application Date:

Membership Category:
MemberAffiliateAssociateIndividual

Institution Name (in full):

Contact Person:

Contact Email:

Policy Provision (e.g., National Water Policy 2000):

Establishing Law (e.g., Water Supply and Sanitation Act No. 28 of 1997):

Regulatory Mandate (Functions of the Regulator):

Service Regulated (e.g., Water supply, sewerage, sanitation):

Organogram or Key Departments (Brief Description):

Title of Head of Institution:

Signature: