SWMOA 2019 Annual Symposium Registration – Riverside, CA (Regulators 50% Discount) “Increasing Membrane Consciousness: How the Southwest Continues to Improve Membrane Treatment” Riverside Convention Center | Riverside, CA (lodging available: The Mission Inn Hotel & Spa) Monday-Wednesday | June 24-26, 2019 RegistrantSalutation*Mr.Mrs.Ms.Dr.First Name*Middle InitialLast Name*Job Title*Company*Address*City*State*Zip/Postal Code*Country*Phone*CellEmail* Enter registered attendee's email addressAttendee materials delivery email optionYes, I would like to have the materials sent to another email addressNo, I would like to have the materials sent to the email aboveAttendee materials will be sent approx. 2 weeks after event, provide an email address compatible to receive and/or access Hightail messages.Attendee materials email address If you prefer to an email other than listed above, provide the email address here. Website Need Contact Hours Certification?*Yes, need contact hours certificationNo, Contact Hours reqiuredLicense #*License State*License Type*License Grade* Special Needs Food Allergies (describe in comments) Gluten Free Meals Halal Meals Vegan Meals Vegetarian Meals Wheelchair Access Other (describe in Comments) Member (check all that apply) SWMOA AMTA Billing Contact InformationEnter billing contact information, if applicableBilling Contact Name First Last Billing Contact Email Billing Contact Phone Communication and Data Sharing PreferenceSWMOA has been diligent in Data Security and being compliant with US and other Nations regulations in sharing your contact information as well as receiving email communications from SWMOA on upcoming events and other resources.I would like to receive email messages from SWMOA about Events, Newsletter or Activities*YesNoAuthorization for receiving publication email notification from SWMOA.(applies to all email addresses on this form)I would like to network with SWMOA Members, Operators, Attendees, Speakers, Moderators, Exhibitors, Sponsors or Board, please share my contact information (cell phone # will not be shared*YesNo Event RegistrationEarly Registration applies to registrations received by May 17, 2019.Today - Date Date Format: MM slash DD slash YYYY Early Registration (Discounted Price Shown Below)*Full Symposium - Members/Affiliates, $400Full Symposium - Non-Members, $500Full Symposium - Speaker/Full-Time Student/Retired, $300One Day Only - Tuesday, $300Half Day Only - Monday, $200Half Day Only - Wednesday, $200Half Day Only - Monday and Wednesday, $400Purchase Materials Only - Cannot Attend, $30Members/Affiliates must be from the list above.Students must be full-time and must submit ID.Registration (Discounted Price Shown Below)*Full Symposium - Members/Affiliates, $450Full Symposium - Non-Members, $550Full Symposium - Speaker/Full-Time Student/Retired, $350One Day Only - Tuesday, $350Half Day Only - Monday, $250Half Day Only - Wednesday, $250Half Day Only - Monday and Wednesday, $500Purchase Materials Only - Cannot Attend, $30Members/Affiliates must be from the list above.Students must be full-time and must submit ID.Will you be staying at the Host Hotel: The Mission Inn Hotel & Spa?*Yes, I will be staying at the host hotelNo, I will not be staying at the host hotelMake your lodging arrangements directly with the The Mission Inn Hotel & Spa by clicking the provided link or by phone at (800) 843‐7755 and refer to SMO06222019 for the discounted room rate. Make your reservations by May 24, 2019 for the discounted rate.How many nights will you be staying at the Host Hotel: The Mission Inn Hotel & Spa?* Event ActivitiesNetworking Reception: Mission Inn Hotel*Mon., Jun. 24 - 4:30-5:30 p.m.Included in your registration fee.Yes, Attending Networking ReceptionNo, not Attending Networking ReceptionGuest/Spouse Attending Network Reception: Mission Inn Hotel?*Yes, Guest/Spouse Attending Networking Reception, $35No, Guest/Spouse Not Attending Networking ReceptionGuest/Spouse Attending Network Reception: Mission Inn Hotel?*Yes, Guest/Spouse Attending Networking Reception, $45No, Guest/Spouse Not Attending Networking ReceptionFacility Tours*Tues., Jun. 25 - 1:15-4:15 p.m.Yes, Attending Facility ToursNo, Not Attending Facility TourNetworking Reception: Baseball Game*Tues., Jun. 25 - 6:00-10:00 p.m.Included in your registration fee.Yes, Attending Networking ReceptionNo, not Attending Networking ReceptionGuest/Spouse Attending Network Reception: Baseball Game?*Yes, Guest/Spouse Attending Networking Reception, $35No, Guest/Spouse Not Attending Networking ReceptionGuest/Spouse Attending Network Reception: Baseball Game?*Yes, Guest/Spouse Attending Networking Reception, $45No, Guest/Spouse Not Attending Networking ReceptionAwards Luncheon*Tues., Jun. 25 - 11:45 - 1:15 p.m.Included in your registration fee.Yes, Attending Awards LuncheonNo, not Attending Awards LuncheonGuest/Spouse Attending Awards Luncheon?*Yes, Guest/Spouse Attending Awards Luncheon, $50No, Guest/Spouse Not Attending Awards LuncheonGuest/Spouse Attending Awards Luncheon?*Yes, Guest/Spouse Attending Awards Luncheon, $60No, Guest/Spouse Not Attending Awards Luncheon Total Registration FeeRegulator 50% Discount50% discount on registration fees $0.00 Total Registration Fee $0.00 Payment InformationPayment Method*Credit Card - Online PaymenteCheck (Bank Wire w/o processing fee) - Online PaymentCheckInvoiceIf paying by check, make payable to: Southwest Membrane Operator Association, and mail to: 1035 E. Vista Way. #103, Vista, CA 92084. CommentsIf you would like a copy of the invoice/receipt sent to another*Yes, send copy of invoice/receipt to:No, don't need a copy sentIf yes, you would like a copy of the invoice/receipt sent to another other than the attendee please enter information below.Name* First Last Email Address* Comments or Instructions Written cancellation requests received by SWMOA on or before May 17, 2019 will receive a refund, less a 25% processing fee. Full payment is required if cancellation is received on or after May 18, 2019 - no refunds and no credits for future events will be granted. However, substitutions may be made at any time. SWMOA reserves the right to make changes in programs and speakers, or to cancel programs when conditions beyond its control prevail. Every effort will be made to contact each enrollee if a program is cancelled. If a program is not held, SWMOA’s liability is limited to the refund of the program fee only. toward the scheduled event. Final Step of Application ProcessCAPTCHAPlease enter the letters displayed above to complete your application and then click Submit.