SWMOA Workshop Registration – San Pedro, CA – May 15, 2017 “Reclamation Membrane Operator Training” Workshop Terminal Island Water Reclamation Treatment Plant Monday, May 15, 2017 | 7:30 a.m. - 4:15 p.m. RegistrantSalutation*Mr.Mrs.Ms.Dr.First Name*Last Name*Job Title*Company*Address*City*State*Zip/Postal Code*Country*Phone*CellFaxEmail* Email Notifications*Yes, I authorize receiving publication email notificationsNo, I would not like to receive publication email notifications (opt-out)Authorization for receiving publication email notification from SWMOA.(applies to all email addresses on this form)Attendee 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 Special Needs Food Allergies (describe in comments) Gluten Free Meals Halal Meals Vegan Meals Vegetarian Meals Wheelchair Access Other (describe in Comments) Workshop RegistrationWorkshop Registration*SWMOA Members, $175.00Non-Members - Certified Ops (includes current year Div 1B SWMOA Membership), $250.00Non-Members - Non-Ops-Individual (includes current year Div 3C SWMOA Membership), $300.00Purchase Materials Only - Cannot Attend, $30For other types of membership - please contact SWMOA for membership application, or click here to apply for membership now. Contact HoursYes, need contact hours certificationNo contact hours requiredfee included in registrationLicense #*License State*License Type*License Grade* Total Registration Fee $0.00 Payment InformationPayment Method*Credit Card - Online PaymenteCheck (Bank Wire w/o processing fee) - Online PaymentCheckInvoiceIf paying by check: Make checks payable to: Southwest Membrane Operator Association (SWMOA) and mail to: 1035 East 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 sentName* First Last If yes, you would like a copy of the invoice/receipt sent to another other than the attendee please enter information.Email Address* If yes, you would like a copy of the invoice/receipt sent to another other than the attendee please enter information. Comments or Instructions Written cancellation requests received on or before May 1, 2017 will receive a refund, less a $50 processing fee. Full payment is required if cancellation is received on or after May 2, 2017 - 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. Final Step of Application ProcessCAPTCHAPlease enter the letters displayed above to complete your application and then click Submit.PhoneThis field is for validation purposes and should be left unchanged.