Attendee Registration Form

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

Aquarius Casino Resort Laughlin, Nevada

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Address: City: State: Zip:





Please check all that apply:


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

Contractor $100:

Spouse/Employee $85:

Thursday evening ONLY guest pass $40:

Friday Lunch only $15:

Student $70:

Scholarship Recipient No charge:

Technical $100:

Non-Exhibiting Manufacturer/Supplier $180:


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.