Local Governments and Stormwater Agencies Membership Application Form Company Street City State/Province Country Proficiency with GSI:--None--Beginner Intermediate Advanced EPA Region:--None--Region 1 - Boston Region 2 - New York City Region 3 - Philadelphia Region 4 - Atlanta Region 5 - Chicago Region 6 - Dallas Region 7 - Kansas City Region 8 - Denver Region 9 - San Francisco Region 10 - Seattle Population Size:--None--1-50,000 50,001-100,000 100,001-200,000 200,001-500,000 500,001-1,000,000 1,000,000 + <100,000 100,000-199,999 200,000-299,999 300,000-499,999 500,000-1M >1M Hope to Gain from Membership?: Able to Fund Membeship Dues?:--None--Yes No First Name Last Name Title Email Phone
