Nebraska Rural Water Association September 24-26, 2019
Western Conference Pre-Registration Gering Civic Center
(* indicates required information) Gering, Nebraska
*Name (1 person per form)  
*Water System or Co. Name Pre-Registration Deadline is September 6th.
*Address $25 fee increase for registrations received
*City, State, Zip between September 6th and September 18th.
Email No registrations after September 18rd.
License numbers MUST be on this form to receive the correct CEUs.
*Do You Have License? License Type *License Number *License Grade  
Yes No Water Operator  
Yes No Backflow  
Yes No Wastewater  
Yes No Well Driller  
Registration fees received after September 6thand on-site will increase by $25.

Days Attending
Member Member
after Sep. 6

after Sep. 6
Pre-Conference (Tuesday) $90.00 $115.00 $115.00 $140.00
Pre-Conference & Conference (Tue - Thur) $180.00 $205.00 $210.00 $235.00
Conference (Wed - Thur) $125.00 $150.00 $150.00 $175.00
Wednesday $85.00 $110.00 $110.00 $135.00
Thursday $90.00 $115.00 $115.00 $140.00
Indicate below if you are participating in the extra activities:
Golf Outing (Tuesday): Yes No  
Trap Shoot (Wednesday): Yes No  
Poker Run (Wednuesday): Yes No  
All meals are included for each registration. Please indicate below if you will be staying for the evening meal. You will not be charged for it if you are registered - it's for a more accurate count. Guests need to purchase a ticket for every meal. The breakfast on Wednesday is complimentary for all registered for the conference.
Meal Attending Attendee Guests Guest Names
Wednesday Banquet $25.00 Guest Name
Thursday Lunch $20.00 Guest Name

Western Conference Fees should be paid in advance to avoid additional charges. You
may mail payment to the NeRWA Office or 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.


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