Attendee Registration Form | Arkansas Rural Water Association

46^th ANNUAL TECHNICAL CONFERENCE & EXHIBITION
of the
ARKANSAS RURAL WATER ASSOCIATION
September 10-13, 2023

"*" indicates required fields

Please submit a separate form for each attendee.
NOTE: All member systems must be pre-registered for the conference by August 11, 2023 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*

Membership Type*

ARWA Member + Aquasure Member

ARWA Member

Non-Member

ARWA Member Registration - Aquasure Member Discount

Price per person. Includes Registration, 2 Continental breakfasts and 2 Luncheons

Price:

ARWA Member Registration

Price per person. Includes Registration, 2 Continental Breakfasts and 2 Luncheons

Price:

Non-Member Registration

Price per person. Includes Registration, 2 Continental Breakfasts and 2 Luncheons

Price:

Spouse Registration

Spouse Name

First Name Last Name

ARWA Golf Tournament

ARWA Golf Tournament Registration Fee

Golf Tournament will be held at the Diamondhead Golf Club

Price: $100.00

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 Due

Payment Method

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

46th ANNUAL TECHNICAL CONFERENCE & EXHIBITION of the ARKANSAS RURAL WATER ASSOCIATION September 10-13, 2023

Spouse Registration

ARWA Golf Tournament

46^th ANNUAL TECHNICAL CONFERENCE & EXHIBITION
of the
ARKANSAS RURAL WATER ASSOCIATION
September 10-13, 2023