Fall Training - Attendee Registration

Step 1 of 2

50%

• MsRWA Fall Training
  October 15 - 17, 2024

• Date*
  MM slash DD slash YYYY
• 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*

• Is your System/You a MsRWA Member*
  (If the system listed above is a member, then all employees are MsRWA Members)
  • Yes, the system above is a MsRWA Member/I am an Individual Member
  • No, Neither the System Above/I am a MsRWA Member.
• Non-Member Attendee Registration*
  Select one
  • Full Fall Registration (Non-Member Rate)- $500
  • Fall Training By The Day (Non-Member Rate) - $250
  • Fall Exhibit Hall Pass - Wednesday Only (No Training Credits) - 100.00
• Member Attendee Registration*
  Select One
  • Full Fall Registration- $250
  • Fall Training By The Day - $125
  • Fall Exhibit Hall Pass - Wednesday Only (No Training Credits) - 100.00
• Which Day*
• Choose your Class Type for each day:*
  • Tuesday, October 14 - Dual Hours (Water& Wastewater)
  • Wednesday, October 15 - Water Hours
  • Wednesday, October 15 - Wastewater Hours
  • Thursday, October 16 - Dual Hours (Water& Wastewater)
• Donation to MsRWA Scholarship Fund
  Enter donation amount (optional)
• Preferred payment method*
  • Pay online w/ credit card
  • Mailing check
  • Paying On-Site
• Total
  $0.00
• Comments
  This field is for validation purposes and should be left unchanged.

Δ