ACWWA 2010 Annual Conference Delegate Registration Form***** FOR TRADESHOW REGISTRATION, CLICK HERE! *****
PART A - General Information (*Required Fields)
Name:
*
Title:
Organization:
Address:
City:
Province/State:
Alberta (AB) British Columbia (BC) Manitoba (MB) New Brunswick (NB) Newfoundland and Labrador (NL) Northwest Territories (NT) Nova Scotia (NS) Nunavut (NU) Prince Edward Island (PE) Saskatchewan (SK) Ontario (ON) Quebec (QC) Yukon (YT) Alabama (AL) Alaska (AK) Arizona (AZ) Arkansas (AR) California (CA) Colorado (CO) Connecticut (CT) Delaware (DE) District of Columbia (DC) Florida (FL) Georgia (GA) Guam (GU) Hawaii (HI) Idaho (ID) Illinois (IL) Indiana (IN) Iowa (IA) Kansas (KS) Kentucky (KY) Louisiana (LA) Maine (ME) Maryland (MD) Massachusetts (MA) Michigan (MI) Minnesota (MN) Mississippi (MS) Missouri (MO) Montana (MT) Nebraska (NE) Nevada (NV) New Hampshire (NH) New Jersey (NJ) New Mexico (NM) New York (NY) North Carolina (NC) North Dakota (ND) Ohio (OH) Oklahoma (OK) Oregon (OR) Pennyslvania (PA) Puerto Rico (PR) Rhode Island (RI) South Carolina (SC) South Dakota (SD) Tennessee (TN) Texas (TX) Utah (UT) Vermont (VT) Virginia (VA) Virgin Islands (VI) Washington (WA) West Virginia (WV) Wisconsin (WI) Wyoming (WY) *
Postal Code:
Country:
Phone Number:
Fax:
Email:
Membership No.:
Registered Companion:
Sector:
Utility Supplier Contractor Consultant
Student Academic Other
PART B - Delegate & Companion Registration
Registration Fees:
$100.00 late charge for registrations
after Aug. 27/10
Click Here to Select Type of Registration Registration Fee Member- $395.00 + $100.00 Registration Fee Non Member- $445.00 + $100.00 Registration Fee Student - $30.00 Day Pass Fee Member (Monday) - $125.00 Day Pass Fee Non Member (Monday) - $150.00 Day Pass Fee Member (Tuesday) - $125.00 Day Pass Fee Non Member (Tuesday) - $150.00
Add Companion ($195.00)
Meals & Activities
Golf (Delegate - $35.00):Golf (Companion - $35.00):Extra Golfers ($35/ea):
No - $0.00 Yes - $35.00 No - $0.00 Yes - $35.00 No - $0.00 1 - $35.00 2 - $70.00 3 - $105.00 4 - $140.00 5 - $175.00 6 - $210.00 7 - $245.00 8 - $280.00 9 - $315.00 10 - $350.00 Sorry, but we are now full for Golf registrations.
Technical Tour (Del - Included):Technical Tour (Comp - Included):
No Thanks Rothesay Millidgeville No Thanks Rothesay Millidgeville
Highlights of Saint John:
Delegate - $10.00 Companion - $10.00
Young Professional Supper:
Delegate - included Companion - included
Saint John River Cruise:(2 hours)
Delegate - $45.00 Companion - $45.00
Meet and Greet:
Monday (Sep 13)
Continental Breakfast:
AGM Luncheon:Companion's Luncheon:
Annual Banquet:
ABEA Hospitality Reception:
Tuesday (Sep 14)
Awards Breakfast:
Box Lunch at Trade Show:Companion's Luncheon:
Uptown Architectural Tour:
Down East Feast (Del - $35.00):Down East Feast (Comp - $35.00):Extra Tickets ($75/ea):
No - $0.00 Yes - $35.00 No - $0.00 Yes - $35.00 No - $0.00 1 - $75.00 2 - $150.00 3 - $225.00 4 - $300.00 5 - $375.00 6 - $450.00 7 - $525.00 8 - $600.00 9 - $675.00 10 - $750.00
Please describe any dietary restrictions
or other special needs you may have
Part B - Subtotal:
Life Members: Select to receive a $100 Discount:
13% HST (869 924 910 RT2):
Select number of entries for the Water for People Fun Run ($25.00/entry):
0 1 - $25.00 2 - $50.00 3 - $75.00
Water For People Fun Run includes a
T-shirt, please select how many
of each size are required.
Small 1 2 3 Medium 1 2 3 Large 1 2 3 X-Large 1 2 3
Part B - Total:
Total Payment:
YOU MUST HAVE JAVASCRIPT ENABLED TO USE THIS FORM! CLICK HERE TO FIND OUT HOW!
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