VRWA Expo 2008 Attendee
Registration
September 17 - 18, 2008
Please use one form for each person attending. Registrations must be postmarked by September 5th to receive the lower rate.
NO registration will be accepted without payment. There will be NO refunds. Please print or type form.
Name: ________________________________________________________________________________________________
Company ______________________________________________________________________________________________
Address ______________________________________________________________________________________________
City _____________________________________________ State ____________________________ Zip_________________
Phone __________________________ Fax ______________________ Email ______________________________________
Tally It Up!
Registration Before September 5th After September 5th
Member $ 40.00 $55.00
Non-Member $ 50.00 $65.00
Grand Total __________________
Please send registration form and check to:
Virginia Rural Water Association
2138 Sycamore Avenue
Buena Vista, VA 24416
NO REGISTRATON WILL BE ACCEPTED WITHOUT PAYMENT AND
— THERE WILL BE NO REFUNDS —
VRWA WELCOMES SUBSTITUTIONS
Check Enclosed __ Visa__ MasterCard__
(Checks payable to VRWA)
Credit Card Number: ___________________________________________________________________________________
Name on Card:_________________________________________________________________________________________
Exp Date: __ __ /__ __ 3 digit sec. code:__ __ __ Card Billing Zip Code: __________________
(on signature strip on back of card)
Signature: ___________________________________________________________ Date:___________________________