16
| Rural Water Association of Arizona
Attendee Registration Form
22
nd Annual Technical Conference
Chandler, AZ - March 5h, 6th, and 7th, 2013
San Marcos Resort & Conference Center
ONE REGISTRANT PER FORM—Please enter badge name information CLEARLY.
Name:
Badge Name:
Employer:
Title:
Address:
City/State/Zip:
Phone/Fax:
Email:
REGISTRATION CATEGORY:
MEMBER
NON-MEMBER
Regular After 2/15/13 Regular After 2/15/13
FULL ANNUAL CONFERENCE
March 5th-7th, 2013…………………………$200
$300
$300
$350
Includes:
Opening Session, Training Sessions & Exhibits
3
HOT Breakfast
Vendor Appreciation Reception
Afternoon Snack Breaks
ONE DAY REGISTRATION
Tuesday, March 5th.………………………………………………………...$90
$115
$115
$145
Includes:
Opening Session, Training Sessions
1
HOT Breakfast
Vendor Appreciation Reception
Wednesday, March 6th………………………………………………………………….$90
$115
$115
$145
Includes:
Exhibits 8:00am to 12:00pm
1
HOT Breakfast
Afternoon Snack Break
Training Sessions
Neal Deal Raffle
Thursday, March 7th…..………………………………………………………………..$80
$105
$105
$130
Includes:
Training Sessions
1
HOT Breakfast
Afternoon Snack Break
SPOUSE/GUEST REGISTRATION (ALL THREE DAYS)
………………...
$100
$145
$145
$170
Includes:
Opening Session, Training Sessions & Exhibits (no PDH’s)
3
HOT Breakfast
Vendor Appreciation Reception
Afternoon Snack Breaks
TOTAL $______________
Payments may be made by check or by credit card. Make all checks payable to “Rural Water Association of Arizona” or
“
RWAA” and mail to:
Rural Water Association of Arizona, Attention: Bunny Kunce, 1075 S. Idaho Rd., Suite 213,
Apache Junction AZ. 85119.
Payments must be received by no later than March 6th, 2013.
No refunds will be made
after Friday, February 15th, 2013.
If your billing address is different from the address listed above, please provide billing
address on a separate sheet of paper.
Credit Card Number
Expiration Date
Card Verification Code
Cardholder Name
Cardholder Signature
Visa
Mastercard
American Express
Discover
Check Enclosed
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ttendee egistration Form
22
nd Annual Technical Conference
Chandler, AZ - March 5h, 6th, and 7th, 2013
San Marcos Resort & Conference Center
ONE REGISTRANT PER FORM—Please enter badge name information CLEARLY.
Name:
Badge Name:
Employer:
Title:
Address:
City/State/Zip:
Phone/Fax:
Email:
REGISTRATION CATEGORY:
MEMBER
NON-MEMBER
Regular After 2/15/13 Regular After 2/15/13
FULL ANNUAL CONFERENCE
March 5th-7th, 2013…………………………$200
$300
$300
$350
Includes:
Opening Session, Training Sessions & Exhibits
3
HOT Breakfast
Vend r Appre iation Reception
Afternoon Snack Breaks
ONE DAY REGISTRATION
Tues ay, March 5th.………………………………………………………...$90
$115
$115
$145
Includes:
Opening Session, Training Sessions
1
HOT Breakfast
Vendor Appreciation Reception
Wednesday, March 6th………………………………………………………………….$90
$115
$115
$145
Includes:
Exhibits 8:00am to 12:00pm
1
HOT Breakfast
Afternoon Snack Break
Tr ining Sessions
Neal Deal Raffle
Thursday, March 7th…..………………………………………………………………..$80
$105
$105
$130
Includes:
Training Sessions
1
HOT Breakfast
Afternoon Snack Break
SPOUSE/GUEST REGISTRATION (ALL THREE DAYS)
………………...
$100
$145
$145
$170
Includes:
Opening Session, Training Sessions & Exhibits (no PDH’s)
3
HOT Breakfast
Vend r Appre iation Reception
Afternoon Snack Breaks
TOTAL $______________
Payments may be made by check or by credit card. Make all checks payable to “Rural Water Association of Arizona” or
“
RWAA” and mail to:
Rural Water Association of Arizona, Attention: Bunny Kunce, 1075 S. Idaho Rd., Suite 213,
Apache Junction AZ. 85119.
Payments must be received by no later than March 6th, 2013.
No refunds will be made
after Friday, February 15th, 2013.
If your billing address is different fr m the address listed above, please provide billing
address on a separate sheet of paper.
Credit Card Number
Expiration Date
Card Verification Code
Cardholder Name
Cardholder Signature
Visa
Mastercard
American Express
Discover
Check Enclosed
:_ ________________________________________________
Badge Name:_______________________________________________
E l
: ______________________________________________
Title: _ _____________________________________________________
Address: _______________________________________________ City/State/Zip: _ ____________________________________________
Phone/Fax: _ ___________________________________________ Email: _____________________________________________________
22
nd
An ual Technical Conferenc
Chandler, AZ - March 5
th
, 6
th
,
and 7
th
, 2013
San Marcos Res rt & Confere c Center