NeRWA Special Training Registration
Nebraska Rural Water Association
Special Classes
Online Registration Form
 
Fields indicated with an asterisk (*) are required information.
 
Name*
 
Address*
 
City*
 
State*
 
Zip Code*
 
System/Company*
 
Telephone
 
Email
 
Licenses Held* Primary Job Function
Yes No Grade Number License Type System Water Operator
Water Operator Backflow Tester
Backflow Board member
Wastewater Factory Rep
Other
 
Class Attending*
 
Please provide any comments in the space at the left.


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.