Annual Conference - Attendee Registration

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• May 27-30, 2025 | Biloxi, MS
• Water/Wastewater System Attendee Name*
  First Last
• Position
• Water Cert
  • Yes
  • No
• Cert #
• Expiration Date
  MM slash DD slash YYYY
• Wastewater Cert
  • Yes
  • No
• Cert #
• Expiration Date
  MM slash DD slash YYYY
• System/Company Name*
• PWS ID#
• Address*
  Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code
• Phone*
• Fax
• Email*

• Are you or the system you work for a member of MsRWA?*
  • Yes
  • No
• MsRWA Member #*
• Member Registration Type*
  • Full Registration - $250 (Exhibit Hall Pass & 2 Shrimp Boil/Fish Fry Passes Included)
  • By The Day Registration - $150 Per Day
  • One Day Exhibit Hall Pass - $100
• Non-Member Registration Type*
  • Full Registration - $500 (Exhibit Hall Pass & 2 Shrimp Boil/Fish Fry Passes Included)
  • By The Day Registration - $300 Per Day
  • One Day Exhibit Hall Pass - $200
• This field is hidden when viewing the form
  Registration Type*
  • Full Registration
  • By The Day Registration
  • One Day Exhibit Hall Pass
• This field is hidden when viewing the form
  Full Registration (Exhibit Hall Pass & 2 Shrimp Boil/Fish Fry Passes Included)*
  • MsRWA System Member -$250
  • Non-Member - $500 Per Day
• Spouse Registration (Exhibit Hall Pass & Shrimp Boil/Fish Fry Pass Included)*
  • Yes, Please add my spouse - $200
  • No, I do not wish to purchase a spouse registration.
• Spouse Name for Badge*
  First Last
• This field is hidden when viewing the form
  By the Day Registration*
  (Fee is per Day)
  • MsRWA System Member - $150 Per Day
  • Non-Member - $300 Per Day
• Which Day*
• This field is hidden when viewing the form
  One-Day Exhibit Hall Pass: Wednesday, May 30th (No CEU Hours)*
  There are no training hours with this pass.
  • Member - $100
  • Non-Member - $200
• Total
  $0.00

• Golf Registration Fees

  (Participants must be registered for full conference, please fill out related forms)
• Golfing*
  • Yes, We will participate in the golf tournament.
  • No, we will not participate in golf tournament.
• Hole Sponsor*
  • No, I do not wish to sponsor a hole -$0.00
  • One Hole Sponsor (Includes 1 Player) -$275
  • Two Hole Sponsor (Includes 2 Players) - $550
  • Three Hole Sponsor (Includes 3 Players) - $825
• Number of Golfers*
  • Golfer included in Hole Sponsorship
  • One Golfer $150
  • Two Golfers $300
  • Three Golfers $450
  • Four Golfers $600
• Golfer's Name*
  First Last
• Golfer's Name*
  First Last
• Golfer's Name*
  First Last
• Golfer's Name*
  First Last
• Mulligans ($20/Each)
  No Mulligans1-Mulligan $202- Mulligans $403 - Mulligans $604 - Mulligans $805 - Mulligans $100

• Other Information:

• Yes, I will be attending the Shrimp Boil/Fish Fry Wednesday, May 28th at Point Cadet Pavilion, Biloxi, MS*
  • Yes, I will be attending the Shimp Boil/Fish Fry
  • No, I will not be attending the Shimp Boil/Fish Fry
• How many Adults and/or Children Over 5 will be attending the Shrimp Boil/Fish Fry with you?*
  Full Registration Attendees get 1 Shrimp Boil/Fish Fry ticket plus 1 free ticket for an Adult or Child Over 5 to accompany attendee.
  Myself OnlyMyself and 1 Guest Over 5Myself and 2 Guests Over 5 (1 Extra Ticket)Myself and 3 Guests Over 5 (2 Extra Tickets)Myself and 4 Guests Over 5 (3 Extra Tickets)Myself and 5 Guests Over 5 (4 Extra Tickets)Myself and 6 Guests Over 5 (5 Extra Tickets)Myself and 7 Guests Over 5 (6 Extra Tickets)Myself and 8 Guests Over 5 (7 Extra Tickets)Myself and 9 Guests Over 5 (8 Extra Tickets)
• How many Children under 5 will be attending the Shrimp Boil/Fish Fry with you? Quantity*
  Children under age of 5 are free, we just number for head count.
  Price: $0.00 Quantity
• Do you need to purchase Extra Lunch Buffett Tickets?*
  • Yes
  • No
• What day(s) will you need the Extra Lunch Buffett Tickets?*
  • Thursday, May 29th
  • Friday, May 30th
• How many Extra Lunch Buffet Tickets for Thursday, May 29th Quantity*
  Price: $35.00 Quantity
• How many Extra Lunch Buffet Tickets for Friday, May 30th Quantity
  Price: $35.00 Quantity

• Will your System Participate in the Water Taste Contest, May 28th @ Shrimp Boil?*
  • No, My System will not be participating.
  • Yes, I will bring my water to the Shrimp Boil @ 6pm.
• Please Upload/Fax Water Contest Form
  Max. file size: 64 MB.

• Donation to Door Prize Sponsor
  Enter donation amount (optional)
• Donation to MsRWA Scholarship Fund
  Enter donation amount (optional)
• Donation to MsRWA RWEAC (Rural Water Emergency Assistance Cooperative)
  Enter donation amount (optional)
• Preferred payment method*
  • Pay online w/ credit card
  • Mailing a check
  • Paying On-site
• Total
  $0.00
• Product Name Quantity
  Price: $0.00 Quantity
• Comments
  This field is for validation purposes and should be left unchanged.

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