26th Annual Water and Wastewater Technical Conference
March 2-4, 2010:  On-Line Pre-Registration Form

Please provide the following contact information:

Full Name
Title
Organization
Mailing Address
City
State
Zip/Postal Code
Work Phone
FAX
E-mail

Guest's Name (if registering)

Please check one of the following:

Manager/Operator        Council/Board Member          Mayor 
Administrative/Clerk            Industry            Guest            Other 

1 day only registration: Tuesday, March 2

1 day only registration: Wednesday, March 3

1 day only registration: Thursday, March 4

Sixteen Water OR Wastewater Certification Hours Awarded

Select one of the check boxes if attending an Exam Refresher Class: 

YES, I will be attending the Class A&B WATER Exam Refresher Class on March 3, 2010
      (fee included in full registration)

YES, I will be attending the Class C&D WATER Exam Refresher Class on March 3, 2010
      (fee included in full registration)

YES, I will be attending the Class C&D WASTEWATER Exam Refresher Class on March 3, 2010
      (fee included in full registration)

I am not attending the full conference - only the checked Exam Refresher Class above.  Fee is $75.00

Select the check boxes if you need:

I am taking the exam (indicate which one):   Choose One: A. I am taking the Class D Water Exam B. I am taking the Class C, B, or A Water Exam. C. I am taking the Class D Wastewater Exam. D. I am taking the Class C, B, or A Wastewater Exam. E. I am not testing but I am taking the Exam Refresher Class.

Class D Water: Please send me a Class D Water Study Guide
               
Class C, B, or A Water:  Click Link: Class C, B, and A Water Suggested Study Material

Please send me a Minnesota Department of Health Water Exam Application

Please send me a Minnesota Pollution Control Agency Wastewater Exam Application

Class D or C Wastewater: Click Link:  Class D and C Wastewater Exam Suggested Study Material

EXAMS will be given by the MDH (Water) or MPCA (Wastewater) on March 4, 2010, at 8:30am.

Full registration includes access to all sessions, Exhibit Hall, luncheons and theme party. 

Choose one of the following options:

  Choose One: Member Fee: $175.00 (per person) Non-Member Fee: $200.00 (per person) Guest $50.00 Exam Refresher Only $75.00 1 day registration Tues March 2 $85.00 1 day registration Wed March 3 $75.00 1 day registration Thurs March 4 $25.00    

Choose a payment option:

A. Choose One: B. I will send a check to MRWA. C. I will call the MRWA office with credit card information.     

GRAND TOTAL DUE:  

This is your invoice - PLEASE PRINT A COPY FOR YOUR RECORDS.
MRWA can now accept credit cards for payment of registration fees.  Please call MRWA
                         at 1-800-367-6792 with your credit card information.

Additional Comments:

Please print this page before submitting to the Minnesota Rural Water Association.
This is your invoice for payment.  Send payment to:
217 12th Avenue SE, Elbow Lake, MN  56531.
You will be registered for the Technical Conference when your payment has been received.

*Cancellation Policy:  Fees will be refunded if written request is received by February 23, 2010.