IndianaWEA.org

2008 Wastewater Challenge

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Complete Detailed Information Below

*Required Fields

Competitive Non-Competitive

I plan to attend the Tuesday night Meet & Greet at Shouts

Company:

*First Name: Middle Initial:

*Last Name:

*Address:

*City: *State: *Zip Code:

*Phone Number:

Email Address:

Certification Number:

Grade/Class: Expiration Date:

	Before April 15th	After April 15th
Member	$30 per person	$50 per person
Non-Member*	$50 per person*	$70 per person*
Non-Member**	$80 per person**	$100 per person**
Judge	$10 per judge	$10 per judge

Note: Make checks payable to: IWEA. Payments must be received with registration. Purchase Orders are accepted only from municipalities and government agencies (Please note purchase order above). Only registrations with Purchase Order # will be accepted by fax at (317)328-2545.

* the non-member rate includes, upon completion of a membership application, membership for one year in the Indiana Water Environ-ment Association (IWEA) ONLY.

** the non-member rate includes, upon completion of the member-ship application, a one-year operator class membership in the Wa-ter Environment Association (WEF) and it’s member association,