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 (NOTE: Price will be $200 per person, after August 11, 2023; $220 at the door)

Price:

ARWA Member Registration

Price per person. Includes Registration, 2 Continental Breakfasts and 2 Luncheons (NOTE: Price will be $215 per person, after August 11, 2023; $240 at the door)

Price:

Non-Member Registration

Price per person. Includes Registration, 2 Continental Breakfasts and 2 Luncheons (NOTE: Price will be $290 per person, after August 11, 2023; $315 at the door)

Price:

Spouse Registration

Spouse Name

First Name Last Name

Spouse Luncheons

$95/person includes two (2) luncheons. *There will be NO Luncheon tickets sold on-site!

Price: $95.00

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

How do you wish to pay?*

Pay online now

Pay by invoice

Payment Method

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Phone

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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