| Nebraska Rural Water Association | |||||||||||||||||||
| Water Operator Continuing Education | |||||||||||||||||||
| Online Registration Form | |||||||||||||||||||
| Fields indicated with an asterisk (*) are required information. | |||||||||||||||||||
| Name* | |||||||||||||||||||
| Address* | |||||||||||||||||||
| City* | |||||||||||||||||||
| State* | |||||||||||||||||||
| Zip Code* | |||||||||||||||||||
| System/Company* | |||||||||||||||||||
| Telephone | |||||||||||||||||||
| Licenses Held | Primary Job Function* | ||||||||||||||||||
| Yes | No | Grade | Number | License Type | System Water Operator | ||||||||||||||
| Water Operator | Board Member | ||||||||||||||||||
| Backflow | State or Federal Rep | ||||||||||||||||||
| Wastewater | Other | ||||||||||||||||||
| Class Attending* | |||||||||||||||||||
| Please provide any comments in the space at the left. | |||||||||||||||||||
Session Fees are due at the class or you may 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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