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 AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest 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) 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 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 Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Expiration Date Security Code Cardholder Name ***A $25 FEE WILL BE CHARGED ON ALL REFUNDS*** Δ