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MRWA PRE-REGISTRATION FORM <br /> This form must be received no later February 21,2005 for preregistration rates to apply. <br /> Mail to:Minnesota Rural Water Association,21712'Avenue SE,Elbow Lake,MN 56531. <br /> Please complete one form for each registrant.Guests may use the same registration form. <br /> 4._..- <br /> U-�) r + Y' <br /> First Name Last Name <br /> 0 ,'4 f ®f Pe- el un� LaVdS <br /> System or C mpany Name <br /> System or Company Address <br /> city State Zip <br /> E-mail Phone <br /> For Office Use Only <br /> Guest's Name(if registering) Date Recd <br /> Please check one of the following: Check# <br /> Amount <br /> Manager/Operator }<:� CounciUl3oard Member Mayor Receipt# <br /> Initials <br /> Administrative/Clerk Industry Spouse Other <br /> DON'T MISS THIS SPECIAL <br /> $15.00 discount on registration price for Mayors,Clerks, and Councilpersons <br /> attending for the first time.Must be accompanied by system operator or manager. <br /> Fall Registration Postmarked prior to On-site Registration <br /> Includes access to all sessions, February 21,2005 <br /> Exhibit Hall,luncheons,and theme <br /> party <br /> $&C�?MRWA Associate Member $100.00(per person) $125.00(per person) <br /> $ Non-Member $125.00(per person) $150.00(per person) <br /> $ Guest $ 40.00 $ 45.00 <br /> $ Total Due(make checks payable to:Minnesota Rural Water Association) <br /> Register online at www.mrwa.com(use the training button). <br /> Copy registration form and mail with payment to the MRWA Office. <br /> Payment Method <br /> A'Check ❑VISA ❑MasterCard <br /> Credit Card#: <br /> Cardholder Name: <br /> Expiration Date: <br /> Signature: <br /> Cancellation Policv:Fees will be refunded if written reanest is received prior to February 21.2005. <br />