MRWS ConferenceSystem Registration PRE-REGISTER BY APRIL 30TH TO AVOID LATE FEESSystem/Company Name*Attendee Name* First Last Title*Operator #*Phone*Email* Address Street Address City 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 State ZIP Code If you don't want your name added to a vendor distribution list, check this box Do not share my info If you don't want your name added to a vendor distribution list, check this boxOperator Certification Track (no CEC's) Quantity Price: $175.00 Quantity (Includes Wed. - Fri. Classes; Wed. Social; Thurs. & Fri. Lunch; and Thursday Banquet)Session Attending Water Wastewater CONFERENCE FEE FOR CEC's - $185 FOR ONE DAY OR ALL THREE DAYS - NO EXCEPTIONS Registration Type*Select your registration type...Operator Certification Track (no CEC's) - $150Early Bird Registration > Member - $250Early Bird Registration > Non-Member - $300Guest Registration Quantity Price: $100.00 Quantity Donation Donation to the MT Rural Water Education FundSelect Your Payment Method* Pay Online Pay by Phone Pay by Check Convenience Fee (3%) Price: $0.00 Total Payment Due $0.00 To pay by check, submit this form and mail your payment to: MRWS 525 Central Ave M6 Great Falls, MT 59401To pay by phone, submit this form then call MRWS office at 406-454-1151 to pay by credit card over the phone. Please note that a 3% convenience fee will be applied for credit card payments.Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20252026202720282029203020312032203320342035203620372038203920402041204220432044 Expiration Date Security Code Cardholder Name ***A $25 FEE WILL BE CHARGED ON ALL REFUNDS*** Δ
