Title Facility City, State Day, Date | Time RegistrantPlease refrain from using all caps/uppercase letters, please use sentence structure letter case.Salutation*Mr.Mrs.Ms.Dr.First Name*Last Name*Company*Job Title*Address*City*State*Zip/Postal Code*Country*AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUSAUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwePhone*CellEmail* Enter registered attendee's email addressWebsite Special Needs*Food Allergies (describe below)Gluten Free MealsHalal MealsPaleo MealsVegan MealsVegetarian MealsWheelchair AccessOther (describe below)Special Needs Comments Member (check all that apply) NWMOA AMTA Billing Contact InformationEnter billing contact information, if applicableBilling Contact Name First Last Billing Contact Email Enter billing contact's email address, if applicableBilling Contact Phone Please send copy of the invoice/receipt to Billing Contact NWMOA - Membrane Operator TrainingWorkshop Registration*Members/Affiliates (must be from the list above), $150.00Non-Members - Certified Ops (includes 1 year Div 1B NWMOA Membership), $200.00Non-Members - Non-Cert. Ops (includes 1 year Div 3A NWMOA Membership), $225.00Non-Members - Non-Cert. Ops (includes 1 year Div 3C NWMOA membership), $275.00TESTING, $0.10For other types of membership - please contact NWMOA for membership application, or click here to apply for membership now. Contact Hours for Water/WastewaterContact Hours for Water/Wastewater, $25.00No Contact Hours RequiredLicense #*License State*License Type*License Grade* Total Registration Fee $0.00 Payment InformationPayment Method*Credit Card - Online PaymenteCheck (Bank Wire w/o processing fee) - Online PaymentCheckInvoiceIf paying by check: Make checks payable to: Northwest Membrane Operator Association (NWMOA) and mail to: 12592 West Explorer Dr., Ste. 200, Boise, ID 83713. CommentsComments or Instructions Cancellations/RefundsWritten cancellation requests received before March 21, 2014 will receive a refund, less a $50 processing fee. Full payment is required if cancellation is received on or after March 22, 2014 - no refunds and no credits for future events will be granted. However, substitutions may be made at any time. NWMOA reserves the right to make changes in programs and speakers, or to cancel programs when conditions beyond its control prevail. Every effort will be made to contact each enrollee if a program is cancelled. If a program is not held, NWMOA’s liability is limited to the refund of the program fee only. CAPTCHAFinally, to prove you're human, enter the characters displayed below.CaptchaPlease refer to NWMOA’s Privacy Policy if you have any questions regarding your preferences.