Backflow Re-Cert Training

When:

May 10, 2018 @ 7:30 am – May 11, 2018 @ 4:30 pm

2018-05-10T07:30:00-05:00

2018-05-11T16:30:00-05:00

Where:

MsRWA
5400 North Midway Road
Raymond
MS 39154

Cost:

175

To Register:

Complete the Registration Form and fax/mail

Or Register Online Below

Please submit a separate form for each attendee.

EVENT INFO

Event Name *

Event Date *

Total Cost

Total fees due for this attendee

ATTENDEE INFO

Attendee Name *

Attendee Phone *

Attendee Email *

Attendee Mailing Address

Attendee Certification #

Expiration Date

SYSTEM INFO

Please list System/Organization Name, Contact Person, Address, Phone & Email Address

How will you pay?

Dropdown

Date

Sending

Affinity Partners

Associate VIP Members

Central Pipe Supply, Inc.

CoBank

Coburn Supply Company

Consolidated Pipe & Supply Company

Core & Main LP

ESG Operations

Industrial Electric Motor Works

Magnolia Pump & Equipment, Inc.

The Nowell Agency Inc.

Southeastern Tank

Southern Corrosion

Southern Pipe & Supply

Tri-State Chlorination

Taylor Power Systems

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