Attendee Registration Form | Arkansas Rural Water Association

45^th ANNUAL TECHNICAL CONFERENCE & EXHIBITION
of the
ARKANSAS RURAL WATER ASSOCIATION
September 11-14, 2022

"*" indicates required fields

Please submit a separate form for each attendee.
NOTE: All member systems must be pre-registered for the conference by August 12, 2022 to be eligible for the grand prize drawing for the 4-wheeler.

Attendee Name*

First Name Last Name

Representing

Address*

Street Address City State ZIP Code

Phone*

Email*

Last 4 of SSN

Enter last four digits of Social Security No. to obtain credit hours (for Water & WW license) or N/A

Do you have any special needs?*

Yes

Please describe*

Registration Type

ARWA Member Registration - Aquasure Member Discount

Price per person. Includes Registration, 2 Continental breakfasts and 2 Luncheons (NOTE: Price will be $210 at the door)

Price: $190.00

ARWA Member Registration

Price per person. Includes Registration, 2 Continental Breakfasts and 2 Luncheons (NOTE: Price will be $230 at the door)

Price: $205.00

Non-Member Registration

Price per person. Includes Registration, 2 Continental Breakfasts and 2 Luncheons (NOTE: Price will be $305 at the door)

Price: $280.00

Spouse Registration

Spouse Name

First Name Last Name

Spouse Luncheons (2)

*There will be NO Luncheon tickets sold on-site!

Price: $85.00

ARWA Golf Tournament

ARWA Golf Tournament Registration Fee

Golf Tournament will be held at the Diamondhead Golf Club

Price: $80.00

ARWA HAS A NO REFUND POLICY FOR REGISTRATION

“An even membership of one-cent per person is included in your registration fee(s) allowing participants in NRWA fundraising activities. This is required by Federal Election Commission laws. If you wish to opt-out please go to the registration desk at the conference for your refund of this one-cent fee”

Total

Payment Method

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Name

This field is for validation purposes and should be left unchanged.

45th ANNUAL TECHNICAL CONFERENCE & EXHIBITION of the ARKANSAS RURAL WATER ASSOCIATION September 11-14, 2022

Registration Type

Spouse Registration

ARWA Golf Tournament

45^th ANNUAL TECHNICAL CONFERENCE & EXHIBITION
of the
ARKANSAS RURAL WATER ASSOCIATION
September 11-14, 2022