53RD ANNUAL WATER AND WASTEWATER OPERATORS' CONFERENCE

ATTENDEE REGISTRATION FORM

Galt House Hotel & Suites, Louisville, Kentucky
April 11 - April 14, 2010

  * (All fields marked with an asterisk are required)
Enter your name as you wish it to appear on your nametag
First Name:  *
Middle Initial:
Last Name:  *
Home Address:
City:
State:
Zip Code:
Agency/Employer:  *
Work Address:  *
Work City:  *
Work State:  *
Work Zip Code:  *
Title:  *
Area Code/Work Phone:  * (Do not include hyphens or spaces)
County:  *
Email Address:
If you have checked the radio button below to receive information via email you must enter your email address here or you will not receive your information
Would You Prefer To Receive KWWOA Information at:   &
Are you currently a KWWOA Member?  *
  Please Check Your Selections Below and Return Your Application With A Check Payable to KWWOA or Pay Online with PayPal  
  (Registration includes: All Technical Sessions, Admittance to Exhibit Hall, Breakfast–Day 1, Lunch–Day 2 and All Evening Social Events)  
  (Select the following box if you have paid membership dues in KWWOA for 2010):  
$100.00
  (Select the following box if you have not paid membership dues in KWWOA for 2010-Selection of this box will pay your dues for 2010):  
$130.00
$135.00
$170.00
  Please Complete The Following Information To Assist In Planning For Evening Functions:  

I Plan To Attend Casino Trip on Monday Evening, April 12 (Cost of this event is included in the conference registration fee and includes bus transportation, buffet dinner, and $5.00 gambling credit).  *
 
If you have selected below to record a birthdate you must select the birthdate here or you will not be able to attend the Casino event.
This is (Required by Casino for this Event)		  
Registrant
Date of Birth:
  *
(Required by Casino for Event):

I Plan To Attend Ohio River Dance Cruise on the Belle of Louisville, Tuesday Evening, April 13 (Cost of this event is included in the conference registration fee).  *
 
If you have selected below for a Guest/Spouse to attend the casino event you must select the birthdate here or they will not be able to attend the Casino event.
This is (Required by Casino for this Event)		  
$30.00
Guest/Spouse Date of Birth:
(Required by Casino for Event):
Guest Name:  *
 
  To register one person and proceed to check out click the Register button. --->
To save this Registration form and fill out another one, then click the Add Additional Registrations button.
  After clicking the register button below, you will be taken to a PRINT screen to PRINT your registration form for your records.
You can pay via CHECK or through PAYPAL. The PayPal button will be at the bottom of the next screen.

*One check may be submitted with multiple registration forms. A separate check may be submitted for guest/spouse payment.

Make Checks Payable to:   KWWOA 2010

Mail To:  KWWOA, P.O. Box 536, Frankfort, KY 40602
  
  (Anyone registering online will receive an email confirmation of registration. Those registering with a check via regular mail will not receive a confirmation of registration.) No Refunds issued after March 15, 2010.  
  FOR MORE INFORMATION CONTACT: Melissa Brothers via phone at (502) 330-9678 or via email at kwwoa@fewpb.net