Workshop/Class Registration-Alternate Payment

Early Bird Rate--Alternate Payment Methods
Since this payment method requires extra processing, there is a $2.00 fee per person for paying using this method. WWWATER suggests paying by ePay instead. Using ePay, you can pay online using a credit card, debit card, or PayPal (no PayPal account is required).

If you would rather pay now, you can pay using a credit card, debit card or PayPal (You do not need a PayPal account to use the service). If you want to use ePay, click here. You will be switched to the ePay form.
Items with a * are required items

My Workshop or Class*

Water/Wastewater Workshop (For Small Systems, see below)$182.00

Participants

Water/Wastewater Long-term Class$1,850.00

Participants

Water or Wastewater Small Systems Workshop-One Day$92.00

Participants
Item subtotal:$0.00

Water -and- Wastewater Small Systems Workshop--Both Days-Package Deal$172.00

Participants

Enter coupon

1 Day SS Workshop begin
Water or Wastewater Small Systems Workshop-One Day
WWWATER Small Systems Workshop Registration and Payment*
Early Bird Rate

Both SS Workshops begin
Water -AND- Wastewater Small Systems Workshops--Both Days-Package Deal
WWWATER Small Systems Workshop Registration and Payment--Special Package Deal*
Early Bird Rate

1.5 Day WS begin
All other Water/Wastewater Workshops
WWWATER Workshop Registration and Payment*
Early Bird Rate

Long-term Classes begin
Water/Wastewater Long-term Class
WWWATER Long-term Class Registration and Payment*
Early Bird Rate

End of LT Class collapse
Date of beginning of workshop or class*

MonthDayYear

Choose Payment Method*
Cash, Check, Money Order, Credit Card/Debit Card or Invoice
Billing Information
Bill to:*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*

Confirmation EmailConfirm email
Add this email to your mailing list?*

Yes, add this email address to your list.No, I do not wish to receive info from you via email.

Card info begin
Card Information
Name on card*

First NameLast Name
Credit card number*
Enter numbers only--no dashes or spaces
Expiration Date*

MonthDayYear
CSC Number*
On back of card
Zip Code*
Enter the ZIP code

Card info end

P1 begin
Registration Information Participant #1
Same info as Billing Information?*

YesNo
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail

Confirmation EmailConfirm email
Add this email to your mailing list?*

Yes, add this email address to your list.No, I do not wish to receive info from you via email.
Employer*
Example: City of Smallville, Arrowhead Boy Scout Camp, etc
Position*
Example: Operator, Administrator, etc.
Add or remove atendee #2

Add attendee #2Remove attendee #2

P1 end

P2 begin
Registration Information Participant #2
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail

Confirmation EmailConfirm email
Add this email to your mailing list?*

Yes, add this email address to your list.No, I do not wish to receive info from you via email.
Employer*
Example: City of Smallville, Arrowhead Boy Scout Camp, etc
Position*
Example: Operator, Administrator, etc.
Add or remove atendee #3

Add attendee #3Remove attendee #3

P2 end

P3 begin
Registration Information Participant #3
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail

Confirmation EmailConfirm email
Add this email to your mailing list?*

Yes, add this email address to your list.No, I do not wish to receive info from you via email.
Employer*
Example: City of Smallville, Arrowhead Boy Scout Camp, etc
Position*
Example: Operator, Administrator, etc.
Add or remove atendee #4

Add attendee #4Remove attendee #4

P3 end

P4 begin
Registration Information Participant #4
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail

Confirmation EmailConfirm email
Add this email to your mailing list?*

Yes, add this email address to your list.No, I do not wish to receive info from you via email.
Employer*
Example: City of Smallville, Arrowhead Boy Scout Camp, etc
Position*
Example: Operator, Administrator, etc.
Add or remove atendee #5

Add attendee #5Remove attendee #5

P4 end

P5 begin
Registration Information Participant #5
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail

Confirmation EmailConfirm email
Add this email to your mailing list?*

Yes, add this email address to your list.No, I do not wish to receive info from you via email.
Employer*
Example: City of Smallville, Arrowhead Boy Scout Camp, etc
Position*
Example: Operator, Administrator, etc.

P5 end

Comments/Notes
Enter any comments, special instructions, or coupon codes here.

Send CC info by mail-BEGIN
Be sure the credit card or debit card information is correct. Then send a copy of this completed form to:

WWWATER
Dale Vanderhoof
610 E Euclid St
McPherson, KS 67460

A confirmation email will be sent to the email address that was entered in the "Billing And Registration" page (Page 3) of this form. If you want to print the form for your records, or to send to us, you need to click the link provided to you in the confirmation email. This will allow you to save the .pdf file to your hard drive. Remember where you saved it (saving it to your Desktop is recommended), then open it and print it from there.

After printing the form, send it to the address above. WWWATER will debit the account when received.

Payment must be received by the deadline, or the next higher deadline will be charged.

You have not yet submitted the form, so be sure to click on "Submit", below, or you will not be registered for the class or workshop, and will not receive the confirmation email.

Send CC info by mail-END

Pay by CC at venue-BEGIN
Be sure you bring the credit card or debit card with you to the workshop or class.

A confirmation email will be sent to the email address that was entered in the "Billing And Registration" page (Page 3) of this form. If you want to print the form for your records, or to send to us, you need to click the link provided to you in the confirmation email. This will allow you to save the .pdf file to your hard drive. Remember where you saved it (saving it to your Desktop is recommended), then open it and print it from there.

Bring the printed form with you to the workshop/class.

You have not yet submitted the form, so be sure to click on "Submit", below, or you will not be registered for the class or workshop, and will not receive the confirmation email.

Pay by CC at venue-END

Pay by check/MO by mail-BEGIN
A confirmation email will be sent to the email address that was entered in the "Billing And Registration" page (Page 3) of this form. If you want to print the form for your records, or to send to us, you need to click the link provided to you in the confirmation email. This will allow you to save the .pdf file to your hard drive. Remember where you saved it (saving it to your Desktop is recommended), then open it and print it from there.

Make checks out to: Dale Vanderhoof, and send the printed form and check or Money Order to this address:

WWWATER
Dale Vanderhoof
610 E Euclid St
McPherson, KS 67460

Be sure to include the check or money order and a copy of this form. After completeing the entire form, print this form out and send it, along with your check, to the address above.

Be sure to bring a copy of the printed form with you to the workshop/class.

Payment must be received by the deadline, or the next higher deadline will be charged.

You have not yet submitted the form, so be sure to click on "Submit", below, or you will not be registered for the class or workshop, and will not receive the confirmation email.

Pay by check/MO by mail-END

Pay by check/MO at venue-BEGIN
A confirmation email will be sent to the email address that was entered in the "Billing And Registration" page (Page 3) of this form. If you want to print the form for your records, or to send to us, you need to click the link provided to you in the confirmation email. This will allow you to save the .pdf file to your hard drive. Remember where you saved it (saving it to your Desktop is recommended), then open it and print it from there.

Make checks out to: Dale Vanderhoof, and bring the printed form and check or Money Order to the workshop/class.

Be sure to bring the check or money order and a copy of this form to the workshop/class.

Payment must be received by the deadline, or the next higher deadline will be charged.

You have not yet submitted the form, so be sure to click on "Submit", below, or you will not be registered for the class or workshop, and will not receive the confirmation email.

Pay by check/MO at venue-END

Pay by cah at venue-BEGIN
Be sure to bring the correcct amount of cash with you to the workshop or class. The Instructor does not usually have change with him.

A confirmation email will be sent to the email address that was entered in the "Billing And Registration" page (Page 3) of this form. If you want to print the form for your records, or to send to us, you need to click the link provided to you in the confirmation email. This will allow you to save the .pdf file to your hard drive. Remember where you saved it (saving it to your Desktop is recommended), then open it and print it from there.

Be sure to bring the cash and a copy of this form to the workshop/class.

Payment must be received by the deadline, or the next higher deadline will be charged.

You have not yet submitted the form, so be sure to click on "Submit", below, or you will not be registered for the class or workshop, and will not receive the confirmation email.

Pay by cah at venue-END

Invoice me-BEGIN
A confirmation email will be sent to the email address that was entered in the "Billing And Registration" page (Page 3) of this form. If you want to print the form for your records, or to send to us, you need to click the link provided to you in the confirmation email. This will allow you to save the .pdf file to your hard drive. Remember where you saved it (saving it to your Desktop is recommended), then open it and print it from there.

Be sure the email address that you entered above is correct and will accept emails from WWWATER. This is where the electronic Invoice will be sent, so be sure the email account is checked regularly. The Invoice is payable within 15 days from receipt. If not paid within that time, there may be a fee added to the amount. See the Invoice for the amount.

Do you need us to send you an invoice by paper instead of by email? If so, please specify that in the "Comments" section of this form. The invoice will then be sent to the address that you enetered in the "Billing" section of the form, so be sure that it is all correct, and that it gets to the correct person!

You have not yet submitted the form, so be sure to click on "Submit", below, or you will not be registered for the class or workshop, and will not receive the confirmation email.

Invoice me-END

I have read the workshop text-BEGIN
If you haven't read the text in red on the workshops page, click on this link to read it. It will open in a new window, so that when you are done, you can close the browser window, and you will be back here.

http://www.wwwater.org/workshops.html
I have read the text in red on the Workshops page of the website.

I have read the workshop text-END

I have read the long-term text-BEGIN
If you haven't read the text in red on the long-term class page, click on this link to read it. It will open in a new window, so that when you are done, you can close the browser window, and you will be back here.

http://wwwater.org/longterm.html
I have read the text in red on the Long-term Classes page of the website.

I have read the long term text-END
Click if you have read the text

YesNo
You will not be able to submit the form unless you agree that you have read the text above. When you click on SUBMIT, the form will be submitted.

Should be Empty:

Early Bird Rate--Alternate Payment Methods

Water or Wastewater Small Systems Workshop-One Day

Water -AND- Wastewater Small Systems Workshops--Both Days-Package Deal

All other Water/Wastewater Workshops

Water/Wastewater Long-term Class

Billing Information

Card Information

Registration Information Participant #1

Registration Information Participant #2

Registration Information Participant #3

Registration Information Participant #4

Registration Information Participant #5