NeRWA Training Online Registration
Nebraska Rural Water Association
Wastewater License Preparation Class
Online Registration Form
Fields Marked with an Asterisk (*) are Required
*Employer (Self if None):
*Business Mailing Address:
*Business City: *State: *Zip Code:
Business Telephone:
*Home Mailing Address:
*Home City: *State: *Zip Code:
Home Telephone:
*Will You Need Required Class Books? ($98.00 per set) Yes No
Do You Want Your Books Shipped? ($13.45 shipping) Yes No
Books Should be Shipped to: Business Home
*Class Attending:
Please provide any questions, remarks
or comments in the space provided
to the right.