WaterEC Conference Registration Form

REGISTRATION FORM - PAGE 1

April 27 - April 27, 2010

Marriott Nashville Airport Hotel
600 Marriott Drive
Nashville, TN, 37214

Do not use all caps.
Bold letters indicate required fields.
Please complete a separate registration form for each person.
This form may be reproduced without the written permission of Forester Media Inc.

1. Registrant Information:
First Name:
Last Name:
Company/Agency/Affiliation:
Address:
City:
State/Province:
Zip/Postal Code:
Country:
Phone:	Format: 000-123-4567
Fax:	Format: 000-123-4567
E-mail:
Web Site Address:

2. Registration Type (Please Select One):
Attendee Speaker/Sponsor/Exhibitor
3. Primary Business (Check only one):
Water Utility/Water District/Water Purveyor/Public Works/Irrigation District Consulting/Engineering/Architectural/Design Landscape/Irrigation/Contractor/Construction/Developer/Pipeline/Drilling Municipal/City/County/Other Local Government State/Federal/Other Government Dealer/Distributor/Manufacturer/Representative Other
4. What is your job title?
Owner/President/Vice President/Elected Official Manager/Director/Foreman/Supervisor/Inspector Director/Chief/Superintendent Engineer/Technician/Specialist/Designer Program Manager/Coordinator/Project Manager/Planner Plumber Other (Specify)
5. Do you know of anyone else who might be interested in attending?
Name:
Company/Agency/Affiliation:
Phone:	Format: 000-123-4567
E-mail:

6. Free Subscription Offer: Yes! I want to receive Water Efficiency magazine FREE No

What format would you like to receive your Magazine?
Print (Free for US & Canadian readers only)
Digital version (e-mailed with a link - Free to qualified readers worldwide)
Both Print & Digital (e-mailed with a link - Free to US and Canadian readers only)

In order to verify your on-line subscription request, we are required to ask a personal identifying question. This information is used SOLELY for the purpose of auditing your request.

What high school did you attend?

7. Sign-up for our Email newsletter. Keep up to date with the latest industry news, events, and trends

For problems or questions, please call (805) 682-1300, x 136. We cannot accept international credit card payments online. To pay for your registration using an International credit card, please call the number listed above, or e-mail abridgers@forester.net.