REGISTRATTION FORM
MSGWA EXPO
February 14-16, 2008
Aquarius Casino Resort in Laughlin, NV
PLEASE
PRINT CLEARLY – This form will be used to produce your badge!
First
Name: _______________ Last Name: ______________________
Company: ________________________________________________
Address: __________________________________________________
City: ________________________ State: _____ Zip: ______________
Telephone: (____)____________ Fax: (____)________________
Email: ________________________________________________
MEMBERS - Please check all that apply:
___Arizona Water Well Association
___Colorado Water Well Contractors Assoc.
___New Mexico Ground Water Association
___Utah Ground Water Association
___Nevada
Ground Water Association
___Other ________________________
Registration Fee includes Thursday,
Friday and Saturday morning continental breakfasts, Friday lunch, Thursday evening Exhibitor’s Reception, admission
to all seminars and Exhibit Hall:
Before
or on After
Jan. 31, 2008 Jan.31, 2008
Contractor ………………..………..........$ 75 $ 95
$_____
Spouse/Employee/Other
[List Name(s) below ]..………………… $ 60 $ 80 $_____
Student ……………………..…………. $ 50 $ 70 $_____
Scholarship
Recipient……………….... $ No Charge
Technical …………………………....... $
75 $ 95 $_____
Non-Exhibiting Mfger/Supplier ...........$125
$150 $___
Donation to
Buck Lively Scholarship
$____
(Cash contributions will be acknowledged before the Auction/Raffle
begins)
TOTAL ENCLOSED: $_____
I/We will donate _______ item(s)
to the Buck Lively Scholarship Auction and Raffle
NOTE: All companies and individuals making donations will be acknowledged as their items are auctioned or raffled off
unless requested otherwise. All income generated for the Buck Lively Scholarship Fund is evenly distributed among the scholarship
programs of the 5 state associations hosting the Expo.
CANCELLATION POLICY: 50% if notified by January 21, 2008;
No refunds after that date.
Name of Spouse/Employee/Other(s): Name: _____________________ Name:_____________________ Name:_________________________
Name: ________________________
Return form and check or to pay by Visa or MasterCard, fax form and
complete information below:
MSGWA
1030 E. Baseline Rd.
#105-1025
Tempe, AZ 85283
Card #: ________________________________
Exp. Date:________________________
Signature/Name on card:_________________
CVV:_________________________
For further information call: (480) 609-3999 or email: msgwa@assocmgrs.com. Fax (480) 609-3939
