io n al
SM
G
ro
ess
The Groundwater
Association
und
w ater
Pr
of
C e r t i fi e d
Certified Groundwater Professional
Retirement Declaration
NGWA
Please note you MUST completely fill out, sign, and return this form to NGWA in order for it to be accepted.
I, (print your name)_________________________________________________________ , hereby declare
that I am no longer actively working in the groundwater industry. I further declare that until this point, I have
maintained my certification in good standing, and have complied with all the proper guidelines for a Certified
Groundwater Professional.
I, (print your name)_________________________________________________________ , understand and
accept the rules for declaring myself retired. I will no longer promote myself as an active Certified Groundwater
Professional, but rather a “Retired in Good Standing” Certified Groundwater Professional. I also understand
that I may not move back into the classification of active once this form has been submitted.
Signature _____________________________________________________________________ Date_________
NGWA
SM
The Groundwater
Association
Address 601 Dempsey Road, Westerville, Ohio 43081-8978 U.S.A.
Phone 800 551.7379 • 614 898.7791 Fax 614 898.7786
Email ngwa@ngwa.org Websites NGWA.org and WellOwner.org