NeRWA Training Online Registration
Nebraska Rural Water Association
Wastewater License Preparation Class
Online Registration Form
 
Fields Marked with an Asterisk (*) are Required
 
*Name:
 
*Employer (Self if None):
 
*Business Mailing Address:
 
*Business City: *State: *Zip Code:
 
Business Telephone:
 
Email:
 
*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.