* REQUIRED

Name for Badge *

Your System or Company *
4 Digit Operator ID# *
Your Title or Position *

Daytime Phone Number*
Billing Address *
City, State Zip *

Please Bill my Employer
I will Pay with Credit Card (after filling out this form the next page will have a spot to pay online)

Email Address *
Confirm Email Address *


Pre-Conference - Tuesday April 13th - No Fee 8 hours All licenses
Track 1 – ‘EPA New Rules and Updates ’
Track 2 – ‘Using our Resources Wisely’
Track 3 – Excel for Operators April 12th & 13th Casper College - 16 hours
I plan to attend: ( TYPE in Track 1, Track 2 or None ) *

Type yes or no. I plan to bring a water sample for the taste test contest. *

FULL REGISTRATION (Does not include Tuesday Pre-Conference) April 14th – 16th
(Includes all technical sessions, Exhibit Hall, breakfast and lunches)

Member – After 02/28/10 - $270
Non-Member – With new Individual Membership through 12/31/10 $275
Non-Member $325
Decision Maker / Clerk $125


Complimentary Banquet Thursday
Do you plan to attend the complimentary banquet Thursday evening TYPE yes or no *
Banquet provided at no cost to attendees. Seating limited to first 325 reservations


Special Registrations (please put in the quantity for each below, 1, 2, 3 etc.)
Wednesday only: (classes, lunch, Exhibit Hall, Game Night) $110 each
Thursday only: (classes, lunch, Exhibit Hall) $110 each
Friday only: (buffet breakfast, classes) $75 each

Additional Meal Tickets (please put in the quantity for each below, 1, 2, 3 etc.)
Lunch Ticket (Wednesday/Thursday) $15 each
Banquet Ticket (Thursday night) $30 each
Breakfast Ticket (Friday morning) $12 each

NO REFUNDS after 2/27/09. Amounts credited to future events.

PAYING ONLINE WITH A CREDIT CARD
Please note: after submitting this form you will be directed to a thank you page.
On that page there will be a Iframe containing our online store. Select the products
you signed up for above to be added to the " shopping cart" once you have
all your products then hit "checkout".
If you have any questions don't hesitate to call us @ 307-436-8636.

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