Online Application

Canadian Ground Water Association Certification

GROUNDWATER DRILLING TECHNICIAN*
GROUNDWATER PUMP TECHNICIAN CLASS 2 *
GROUNDWATER PUMP TECHNICIAN CLASS 1*

* indicates required fields

Personal Information	Company Information
Name: * Address: * City: * Province: * Postal: * Phone: * Fax: Email: *	Company: Address: City: Province: Postal: Phone: Fax: Email:
Additional Information
Member of the Provincial Ground Water/Water Well Association? Yes No  *
If a member indicate what province:	Select Province.. Alberta British Columbia Manitoba New Brunswick Newfoundland Labrador Nova Scotia Northwest Territories Ontario Prince Edward Island Quebec Saskatchewan Yukon
If a member please provide proof of membership: (attach scanned copy of document)
Click 'browse' to locate file on your computer. Only   Word .Doc, Image and Plain Text files allowed.
Are you a Journeyman?	Yes No  *
If you are a Journeyman indicate which trade:
Waterwell Driller Plumber Electrician
Journeyman Certificate #, if applicable
Proof of Trade Time/Experience: (2 year min.) (select type of proof submitting, then attach below) *
Affidavit Statutory Declaration Regulatory Agency Letter
Click 'browse' to locate file on your computer. Only   Word .Doc, Image and Plain Text files allowed.
Payment of Fees *	Member $100.00 +HST/GST
Please review the form to ensure that all *required fields are filled in before submitting.