NeRWA Training Registration

Nebraska Rural Water
Annual Conference Registration

To pre-register for the Annual Conference complete the following form.
* indicates required information


*Name
*System

*Address
Your Job title is:

*City
Operator

*State Board Member

*Zip Code Sales Rep or Factory Rep

*Telephone
Backflow Tester or Plumber

E-mail Voting Delegate

*Choose the days you will attend *Please Indicate certificates held and Number.

Water Operator Yes No Lic #

Backflow Yes No Lic #

Wastewater Yes No Lic #

Onsite Wastewater Yes No Lic #

Well Drillers Yes No Lic #

Operators serving water systems of 3,300 or less are eligible for reimbursement from DHHS. You do not have to be a member of NeRWA for eligibility. NeRWA will bill the DHHS directly for reimbursement so do not send payment.

*System eligable for DHHS funding   Yes   No

*Nebraska Public Water System ID Number     NE31

If you have questions or comments, please provide them in the area provided, thank you.

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