Nebraska Rural Water Association
Grade 6 - Backflow Prevention &
Cross-Connection Control Course

  Fields indicated with an asterisk (*) are required information
*Class Attending
  October 7 - 11, 2019
  January 13 - 17, 2020

$500 - NeRWA Members

$550 - All Others
*Employer(self if none):
*Business Address:
*City, State, Zip:
*Business Phone:
Home Address:
Home City, State, Zip:
Home Phone:

Session Fees are due at the class or you may pay online. To Pay online,
press the Submit button and you will go to the Registration Confirmation
Page. You can then select the option Pay Now and you will be directed to
our PayPal pay site.