NeRWA Training Registration

Nebraska Rural Water
Utility EXPO Registration

To pre-register for the Utility EXPO 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

If you have questions or comments,
please provide them in the area
provided, thank you. *Please Indicate certificates held and Numbers.

Water Operator Yes No Lic #

Backflow Yes No Lic #

Wastewater Yes No Lic #

Onsite Wastewater Yes No Lic #

Well Drillers Yes No Lic #

Size of System You Are Representing Less than 3,300 Population

Between 3,300 and 10,000 Population

Over 10,000 Population

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