MsRWA Annual Conference – Attendee Registration Step 1 of 3 33% May 4-7, 2020 | Jackson, MSAttendee Name* First Last PositionWater CertYesNoCert #Expiration Date Date Format: MM slash DD slash YYYY Wastewater CertYesNoCert #Expiration Date Date Format: MM slash DD slash YYYY System/Company Name*PWS ID#Address* Street Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone*FaxEmail* Registration Type*Full RegistrationBy The Day RegistrationOne Day Exhibit Hall PassFull Registration (Exhibit Hall Pass included)*Select your membership typeMsRWA System Member - $205Non-Member - $410Spouse Registration(Exhibit Hall Pass included) Price: $125.00 Quantity: Spouse Name for Badge First Last By the Day Registration*MsRWA System Member - $130Non-Member - $180Which Day*One-Day Exhibit Hall Pass: Wednesday April 1st*There are no training hours with this pass.Member - $75 eachNon-Member - $150 eachTotal $0.00 Golf & Clay Shoot Registration Fees(Participants must be registered for full conference, please fill out related forms)Hole Sponsor (Includes 1 player)Enter quantity Price: $250.00 Quantity: Player(s)Enter quantity Price: $110.00 Quantity: Mulligans (Includes 2)Enter quantity Price: $10.00 Quantity: Clay Shoot SponsorEnter quantity Price: $100.00 Quantity: Clay ShooterEnter quantity Price: $75.00 Quantity: Additional OptionsAttorney Training(Agenda to follow) Price: $150.00 Quantity: Office Training(Agenda to follow) Price: $125.00 Quantity: Donation to MsRWA Scholarship FundEnter donation amount (optional) Preferred payment methodPay online w/ credit cardMail a checkOtherTotal $0.00 NameThis field is for validation purposes and should be left unchanged.
