Attendee Registration Form

Mountain States Ground Water Expo | February 8, 2018 - February 9, 2018

Aquarius Casino Resort Laughlin, Nevada

Keep this field blank:

Full Name*:

Company:

Address: City: State: Zip:

Telephone:

Fax:

E-Mail*:


MEMBERS

Please check all that apply:








Tickets

Registration Fee includes Thursday and Friday morning continental breakfasts, Friday lunch,Thursday evening Exhibitor’s Reception, admission to all seminars and Exhibit Hall:

Contractor - $80 ($100 after January 31, 2018 and onsite)

Spouse/Employee [List Name(s) Below] - $65 ($85 after January 31, 2018 and onsite)

Thursday evening ONLY guest pass $30 ($40 after January 31, 2018 and onsite)

Friday Lunch only $15

Student $50 ($70 after January 31, 2018 and onsite)

Scholarship Recipient No charge

Technical $80 ($100 after January 31, 2018 and onsite)

Non-Exhibiting Manufacturer/Supplier $140 ($180 after January 31, 2018 and onsite)


Spouse/Employee/Other(s)

First and Last name of Spouse/Employee/Other(s):

First Name: Last Name:

First Name: Last Name:

First Name: Last Name:

First Name: Last Name:


I/We will donate item(s) to the Buck Lively Scholarship Auction and Raffle

I would like to donate $ to the Buck Lively Scholarship Fund.

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 31, 2018; No refunds after that date.