2019 Office Professionals’ Seminar

October 29-30, 2019

The Lodge of Four Seasons

315 Four Seasons Drive

Lake Ozark, MO 65049

2019 Office Professionals' Seminar Registration Form

• Name*
  First Last
• Job Title*
• Is spouse attending?*
  Spouse attendance is UNELIGIBLE for MoDNR re-cert hours. Spouses signing roster for credit without paid registration will be billed full member rate.
  • YES
  • NO
• Spouse Name*
  Enter spouse name as you wish it to appear on nametag.
  First Last
• System Representing*
• Billing Address*
  If paying by debit/credit card, the address MUST match the address associated with the card.
  Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code
• Mailing Address*
  • Same as Billing Address
  • Different than Billing Address
• Street Address (Mailing)*
• Address Line 2 (Mailing)
• City (Mailing)*
• ZIP Code*
• Phone*
• Email*
• IF YOU ARE USING BLUE VOUCHERS TO PAY FOR REGISTRATION,

  YOU MUST SIGN THE DAILY ROSTER REGARDLESS OF YOUR CERTIFICATION STATUS.

  FAILURE TO DO SO WILL RESULT IN YOUR SYSTEM BEING BILLED FOR REGISTRATION.

• Membership Status/Payment Type*
  Please select your membership/payment combination. (Regulatory agencies receive the member rate. This DOES NOT apply to water/wastewater systems owned/operated by a governmental entity.
  • Member - Debit/Credit - $190.00
  • Non-Member - Debit/Credit - $375.00
  • Member - BLUE VOUCHER - $190.00
  • Non-Member - BLUE VOUCHER - $375.00
  • Member - Check/Money Order - $190.00
  • Non-Member - Check/Money Order - $375.00
• Please mail check/money orders or BLUE Vouchers/Voucher Forms to:

  MRWA

  901 Richardson Drive

  Ashland, MO 65010

• Total
  $0.00
• Credit Card
  ATTENTION: TO AVOID THE POSSIBILITY OF DUPLICATE CHARGES, DO NOT "GO BACK" OR REFRESH YOUR BROWSER AFTER HITTING THE SUBMIT REGISTRATION FORM BUTTON.
  American Express

  Discover

  MasterCard

  Visa

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