240712 01/07/15 C�q�
CITY OF CARMEL, INDIANA VENDOR: 362435
d i' ONE CIVIC SQUARE INDIANA SECTION AWWA CHECK AMOUNT: $*****1,475.00*
CARMEL, INDIANA 46032 5265 E 82ND STREET SUITE 310 CHECK NUMBER: 240712
'M�or;.c��r INDIANAPOLIS IN 46250 CHECK DATE: 01/07/15
. t�
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
601 5023990 22015 1,475.00 OTHER EXPENSES
107th Annual Meeting
M- LANA SECHON AWWA
Marriott Hotel-Indianapolis,IN
Februarlj 10-12,2015
E G I S
U T I L I T Y 1 0 P E R A T 0 R I G 0 V E R N M E N T
NAME:
'p"rho 5 / U/' (only one name perform) AWWA MEMBER#: b a Lf "S9
Last First Initial
TITLE: 5Yy060_lAwle- L ORGANIZATION: �'/T� 9490,66
ADDRESS: 3 L15-D [A)• / 3 St 5f-
CITY
d
CITY I STATE I ZIP: Ic hgo1!£L VPU. ly"k
OFFICE TELEPHONE: I 31? / 7 3 - 9 K5- FAX: ( 317 73 3 O
k
EMAIL:
REGISTRATION FEES
Employees of Companies holding a Service Provider membership qualify for the Member rates.
Full conference-member* advance:$125 ❑ On-site:$185 °
Full conference-non-member* ❑ Advance:$215 ❑ On-site: $265 t a°mow
One day-member* Advance:$100 ❑ On-site: $135 Day:
One day-non-member* ❑ Advance:$195 ❑ On-site: $230 Day:
*A$10.00 fee will be charged for all on-site name changes on pre-registration name badges.
COMPLIMENTARY REGISTRATIONS
❑ Student,full-time ❑ Retired (AWWA members only)
❑ Guest(Admittance to receptions only) Name:
EARLY BIRD REGISTRATION
Monday, Feb.9, 3:00-7:00 p.m.
MEALS-Tickets required '
a•+esday, Feb. 10, 12-noon: Keynote luncheon-$25 °
Wednesday,Feb. 11, 12-noon:Awards luncheon-$25 '
[]Thursday,Feb. 12,7:30 a.m.:Breakfast-$15
--------------------------------------------------------------------------------------------- ---9-------
T.Ud Amount Enclosed I a 5- W Return this completed form with payment to the address below or visit www.inawwa.orgto register online.
v6heck made payable to Indiana Section AWWA is enclosed. (Check no.: )
❑ Please charge to my: ❑Visa ❑ MasterCard ❑American Express ❑ Discover
Name as it appears on card:
Billing address:
Card number: Exp.date: Signature:
ONLY ONE NAME PER SPECIAL NEEDS REFUND POLICY RETURN COMPLETED
FORM,PLEASE Every reasonable effort will be You can recover your pre-pay- FORM TO:
Photocopy the registration made to accommodate special ment by written request, post- Indiana Section AWWA
form for use by others needs. Please contact Dawn marked no later than Jan.1, 5265 E.82nd Street
or go to our web site for additional Keyler at(866)213-2796 or 2015,to Dawn Keyler. Suite 310
Indianapolis, IN 46250
forms or to register online. dawn.keyler@inawwa.org Request for refunds made after Office: (866)213-2796
www.inawwa.org with your request. that date cannot be honored. FAX: (866)215-5966
107th Annual Meeting
R'qDLANA
Marriott Hotel-Indianapolis,IN
February 10-12,20 5
U T I L I T Y 1 0 P E R A T 0 R I G 0 V E R N M E N T
NAME: 14 OuLiq 1,j n gFm, 6&; ' (only one name perform) AWWA MEMBER#:
Last First Initial
TITLE: , '• ORGANIZATION: CA rz "
`'cL'-'A-r-
ADDRESS: 3 4 (3 LI) ��L 1 S T S`TI?�'�•�/�
CITY I STATE I ZIP: e44-a^
OFFICE TELEPHONE: (3�) 7 3 3 - 7-9S S-57 FAX: ( )
EMAIL:
REGISTRATION FEES
Employees of Companies holding a Service Provider membership qualify for the Member rates.
Full conference-member* ❑ Advance: $125 ❑ On-site: $185
Full conference-non-member* ;�Advance:
vance:$215 ❑ On-site:$265One day-member* $100 ❑ On-site: $135 Day: D'a''�
One day-non-member* ❑ Advance:$195 ❑ On-site: $230 Day:
*A$10.00 fee will be charged for all on-site name changes on pre-registration name badges.
COMPLDAENTARY REGISTRATIONS
❑ Student,full-time ❑ Retired (AWWA members only) _•: :• ::1, �;:t, F. ,: .
❑ Guest(Admittance to receptions only) Name:
EARLY BIRD REGISTRATION
Monday, Feb.9,3:00-7:00 p.m.
MEALS-Tickets required
❑Tuesday,Feb. 10, 12-noon:Keynote luncheon-$25
Aednesday,Feb. 11, 12-noon:Awards luncheon-$25
❑Thursday,Feb. 12,7:30 a.m.:Breakfast-$15
$
----------------------Q-----------------------------------------------------------------------------------
Total Amount Enclosed: 1 15 - Q Return this completed form with payment to the address below or visit www.inawwa.org to register online.
,�aeck made payable to Indiana Section AWWA is enclosed. (Check no.: )
❑ Please charge to my: ❑Visa ❑ MasterCard ❑American Express ❑ Discover
Name as it appears on card:
Billing address:
Card number: Exp. date: Signature:
ONLY ONE NAME PER SPECIAL NEEDS REFUND POLICY RETURN COMPLETED
FORM,PLEASE.' Every reasonable effort will be You can recover your pre-pay- FORM TO:
Photocopy the registration made to accommodate special ment by written request, post- Indiana Section AWWA
form for use by others needs. Please contact Dawn marked no later than Jan.1, 5265 E. 8e 3d10 Street
or go to our web site for additional Keyler at(866)213-2796 or 2015,to Dawn Keyler. SuiIndianapolis, IN 46250
forms or to register online dawn.keyler@inawwa.org Request for refunds made after Office:(866)213-2796
www.inawwa.org with your request. that date cannot be honored. FAX: (866)215-5966
107th Annual Meeting
MMA SECTION AWWA
Marriott Hotel-Indianapolis,IN
February 10-12,2015
UTILITY / OP E RAT 0 RIG O V E R N M ENT
NAME: 14 S-"y4,j tS`t)1q �L/,i.J I N (only one name per form) AWWA MEMBER M � � `� � r(.�
Last First Initial
TITLE: II II ORGANIZATION:
ADDRESS: J' `-two L') I s 1 S-y— ST
CITY I STATE I ZIP: �14 'h �L a7 j �(o � � 7
OFFICE TELEPHONE: (3_�) 7 3 -Z FAX: (—)
EMAIL:
REGISTRATION FEES {
Em to ees of Companies holding a Service Provider membership qualify for the Member rates.
'-�• •'e. ' ®„ ` u �
Full conference member ❑ Advance:$125 ❑ On-site: $185
Full conference non-member dvance: $215 El On-site:$265 >.. • _ :.� "- �:�'�'. "�' : <h,��` r.
F '
ID
One day-member* ZAdvance:$100 ❑ On-site:$135 Day: 157P% r°•- s;
N
"s One day-non-member* ❑ Advance:$195 ❑ On-site: $230 Day:
A$10.00 fee will be charged for all on-site name changes on pre-registration name badges.
COMPLIMENTARY REGISTRATIONS ;. ..
❑ Student,full-time ❑ Retired(AWWA members only)
} ❑ Guest(Admittance to receptions .>'' . ;g=•:" 4
only) Name: r e1 ,� � .ii �
a EARLY BIRD REGISTRATION "
R.,. Al�4
Monday,Feb.9,,3:00-7:00 p.m.
MEALS—Tickets required
❑Tug day, Feb. 10, 12-noon:Keynote luncheon-$25
ednesday, Feb. 11, 12-noon:Awards luncheon-$25 �t
❑Thursday,Feb. 12,7:30 a.m.:Breakfast-$15
-i--------------------------P---------Py-----------------------------9--9-------
TOW Amount Enclosed: ) �� UQ Return this completed form with payment to the address below or visit www.inawwa.or to register online.
heck made payable to Indiana Section AWWA is enclosed. (Check no.: )
❑ Please charge to my: ❑Visa ❑ MasterCard ❑American Express ❑ Discover
Name as it appears on card:
Billing address:
Card number: Exp,date: Signature:
ONLY ONE NAME PER SPECIAL NEEDS REFUND POLICY RETURN COMPLETED
FORM, PLEASE Every reasonable effort will be You can recover your pre-pay- FORM TO:
Photocopy the registration made to accommodate special ment by written request, post- Indiana Section AWWA
form for use by others needs. Please contact Dawn marked no later than Jan.1, 5265 E.82nd Street
or go to our web site for additional Keyler at(866)213-2796 or 2015,to Dawn Keyler. Suite 310
forms or to register online dawn.keyler@inawwa.org Request for refunds made after Indianapolis, IN 46250
Office: (866)213-2796
www.inawwa.org with your request. that date cannot be honored. FAX: (866)215-5966
107th Annual Meeting
INDMA JL A AWWA
Marriott Hotel-Indianapolis,IN
February 10-12,2015
U T I L I T Y / 0 P E R A T 0 R / G O V E R N M E N T
NAME: L/V V'--rV Tr— (only one name per form) AWWA MEMBER#:
Last First Initial
TITLE: II ORGANIZATION: �A►2,w1,� L (,J,g T
ADDRESS: 3`II�-IT O S T S-T�
CITY I STATE I ZIP: a7'i zA 6 7
OFFICE TELEPHONE:(31 7 3 3 --2--le 5-57 FAX:
EMAIL:
REGISTRATI®N FEES n,s. 'X 1 , ` _ . ,.Oxy;
_ G `
5 D D • D K 1 1 q. ,
Employees of Companies holding a Service Provider membership qualify for the Member rates. s4
.�} •,tic...,`.,�Y.0#�� . `` R , G. a
Full conference-member ❑ Advance: 125
$ ❑ On-site: $185
Full conference-non-member $ 5 ❑ On-site:$265
❑ Advance: 21 �� _ }"• ..,�`== �� .���, .
One day-member* i&Advance:$100 ❑ On-site: $135 Day:
One day-non-member* ❑ Advance:$195 ❑ On-site: $230 Day:
*A$10.00 fee will be charged for all on-site name changes on pre-registration name badges.
COMPLRAENI'ARY REGISTRATIONS
❑ Student,full-time ❑ Retired(AWWA members only) ;,.-t•.:h:_ s ;,� ;;•h ,�..
r ❑ Guest(Admittance to receptions only) Name: • a
EARLY BIRD REGISTRATION
Monday, Feb.9,3:00-7:00 p.m. '
MEAL Tickets requiredP-TG .e�.; -0-"•
esday,Feb. 10, 12-noon:Keynote luncheon-$25
❑Wednesday, Feb. 11, 12-noon:Awards luncheon-$25 • 1
[]Thursday,Feb. 12,7:30 a.m.:Breakfast-$15
---------------------------------------------------- --------- ------------------------------ --9-------
TOW Amount EnCloseCl $—f a`fS- (1D Return this completed
p
form with payment to the address below or visit www.inawwa.or9 to register online.
heck made payable to Indiana Section AWWA is enclosed. (Check no.: )
❑ Please charge to my: ❑Visa ❑ MasterCard ❑American Express ❑ Discover
Name as it appears on card:
Billing address:
Card number: Exp.date: Signature:
ONLY ONE NAME PER SPECIAL NEEDS REFUND POLICY RETURN COMPLETED
FORM,PLEASE Every reasonable effort will be You can recover your pre-pay- FORM TO:
Photocopy the registration made to accommodate special ment by written request, post- Indiana Section AWWA
form for use by others needs. Please contact Dawn marked no later than Jan.1, 5265 E.82nd Street
or go to our web site for additional Keyler at(866)213-2796 or 2015,to Dawn Keyler. Suite 310
forms or to register online dawn.keyler@inawwa.org Request for refunds made after Indianapolis, IN 46250
Office:(866)213-2796
www.inawwa.org with your request. that date cannot be honored. FAX-(866)215-5966
107tH Annual Meeting
INDLANA SECTION AWWA
Marriott Hotel-Indianapolis,IN
February 10-12,2015
U T I L I T Y 1 0 P E R A T 0 R 1 G 0 V E R N M E N T
NAME: �cDD L S:'L(_� S1/)4 W ,— (only one name per form) AWWA MEMBER#:
Last First Initial
TITLE: ORGANIZATION: �A►'LWI�Z;� t,Ja�-
ADDRESS: 3 4-s7 o L�) L 5-r s-7—ag,/
CITY/STATE 1 ZIP: e-19-� ISL a7,j
OFFICE TELEPHONE: (3�) 7 3 3 —Z AS S S_ FAX:
EMAIL:
REGIS %F`:r �ti` ., „ ,y ...
TRAMN FEES M :; r -y.^ , : ;: ... .,
Employeesk f of Com Companies holding a Service Provider membership qualify for the Member rates. - ;
Y
` a= Full conference-member* $ ❑ On-site: $185 '` t
❑ Advance: 125 .•:
R;: :a "af:`:. t:t p; ky,:�lLfi�`�•, r.l, rrc+.:..i;' 2;; T-• '
.�" Full conference non-member* ❑ Advance: 21 •R�' _ �� i -�~" �. - -�"` °: <.°M: �;
$ 5 ❑ On-site:$265 ..�. z�r� � � :�•s,� �- r.� .�...�;' � `_
One day-member* Advance:$100 ❑ On-site: $135 Day:
�•}= One da non-member* ❑ Advance:$195 ❑ On-site:$230 Day:
ry {= *A$10.00 fee will be charged for all on-site name changes on pre-registration name badges.
r, COMPLD4ENTARY REGISTRATIONS t .
❑ Student full-time ❑ Retired(AWWA members only)
MR
❑ Guest(Admittance to receptions only) Name:
r: F EARLY BIRD REGISTRATION>
Monday, Feb. 9,3:00-7:00 p.m.
Tickets required e 4t
i �y, Feb. 10, 12-noon:Keynote luncheon e e
$25
e e e
❑Wednesday, Feb. 11, 12-noon:Awards luncheon-$25 e e e F e
7 ❑Thursday, Feb. 12, 7:30 a.m.:Breakfast-$15
---------------------------------------------------------------------------------------------------------
Total Amount Enclosed:$ 1 D-5 I C>0 Return this completed form with payment to the address below or visit www.inawwa.org to register online.
eck made payable to Indiana Section AWWA is enclosed. (Check no.: )
❑ Please charge to my: ❑Visa ❑ MasterCard ❑American Express ❑ Discover
Name as it appears on card: zi
Billing address:
Card number: Exp,date: Signature:
ONLY ONE NAME PER SPECIAL NEEDS REFUND POLICY RETURN COMPLETED
FORM,PLEAS ' Every reasonable effort will be You can recover your pre-pay- FORM TO:
Photocopy the registration made to accommodate special ment by written request,post- Indiana Section AWWA
form for use by others needs. Please contact Dawn marked no later than Jan.1, 5265 E. 82nd Street
or go to our web site for additional Keyler at(866)213-2796 or 2015,to Dawn Keyler. Suite 310
Indianapolis, IN 46250
forms or to register online dawn.keyler@a inawwa.org Request for refunds made after Office: (866)213-2796
www.inawwa.org with your request, that date cannot be honored. FAX: (866)215-5966
107th Annual Meeting
MMA SECTION
Marriott Hotel-Indianapolis,IN
February 10-12,2015
U T I L I T Y 1 0 P E R A T 0 R 1 G 0 V E R N M E N T
NAME: SOA 1-r _ - (only one name perform) AWWA MEMBER#: `t
Last First Initial
TITLE: ORGANIZATION: C4a,M jr L. ;'a•-r-6-
ADDRESS:
ADDRESS: 3 4_s7 o L')
CITY 1 STATE 1 ZIP: �s9—�.W� ►�L :7:7i.,f �(o 6 �
z OFFICE TELEPHONE:(3�) 7 3 3 -2--%r 557 FAX: (-)
EMAIL:
REGISTRATION FEES + 1 f h
�,.,-"fib � s_.,�� �.. �•r�.�.r;:,.`��
Employees of Com
�.•� parties holding a Service Provider membership qualify for the Member rates.
->:�• ;gig..t. r : >='�:;:�ji ;.: •.•',� _�� Fp-�•t^:`
- ,� Full cont �� ..�t :=� ;��r1:, �:. •+- ., � A:., -
k. erence-member* ❑ Advance: $125 ❑ On-site: $185
' h Y �'.*,a{{. 7'� p.;' 4L::�n.:. t k.'X,�K .• .\. °+.i;�f'e5 0 SIF'�*` '��
Full conference•rton-member ❑ Advance: $215 ❑ On $265
x + One day member* dvance: $100 ❑ On-site: $135 Day: 7���► 7�✓fir
"-f One day-non-member* Advance: $195 On-site:$230 Day:
* 11El4^fir.
A$10.00 fee will be charged for all on-site name changes on pre-registration name badges. F
'R COMPLIMENTARY REGISTRATIONS k
� Tff ❑ Student,full-time ❑ Retired (AWWA members only) 4,
{ ="'.` ❑ Guest(Admittance to receptions only) Name: -
EARLY BIRD REGISTRATIONwtn2 r gin` xzn °#` y;
�' Monday, Feb.9, 3:00-7:00 p.m. Irl ' •' - ;> "^',- .,;�: a
a.�.ri`' \ ,j.� 1 1•r 2S�F'n�.'tTr_._...{ 1,.6' 'gid
MEALS—Tickets required `( \r&'S , , • 1 '1 1 { ^' '` •
❑Tuesday, Feb. 10, 12-noon:Keynote luncheon-$25 1 1 1
ednesday, Feb. 11, 12-noon:Awards luncheon-$25 _
❑Thursday,Feb. 12,7:30 a.m.:Breakfast-$15
---------------------- -------------------------------------- ----------------------------- -- -------
Total Amount Enclosed RetReturnp
this completed form with ayment to the address below or visit www.inawwa.or9 to register online.
❑ Check made payable to Indiana Section AWWA is enclosed. (Check no.: )
❑ Please charge to my: ❑Visa ❑ MasterCard ❑American Express ❑ Discover
Name as it appears on card:
Billing address:
Card number: Exp.date: Signature:
ONLY ONE NAME PER SPECIAL NEEDS REFUND POLICY RETURN COMPLETED
FORM,PLEASE Every reasonable effort will be You can recover your pre-pay- FORM TO:
Photocopy the registration made to accommodate special ment by written request, post- Indiana Section AWWA
form for use by others needs. Please contact Dawn marked no later than Jan.1, 5265 E. 82nd Street
or go to our web site for additional Keyler at(866)213-2796 or 2015,to Dawn Keyler, Suite 310
Indianapolis, IN 46250
forms or to register online dawn.keyler@inawwa.org Request for refunds made after Office: (866)213-2796
www.inawwa.org with your request. that date cannot be honored. FAX:(866)215-5966
as •�•, x �, .�. :._ � ..M�, .�,,. ;r -
r . : 107tH Annual Meetin6
nRqDIANA SECTION AWWA
Marriott Hotel-Indianapolis,IN
~� Feb,uary 10-12,2015
Nr
po
F4; U T I L I T Y 1 0 P E R A T 0 R / G 0 V E R N M E N T
NAME: Te��f ;mss /G'�,�i
fast '� (only one name perform) AWWA MEMBER#: f)a Z
"rt.Ti first Initial
•��s TITLE: ORGANIZATION: C.:r l o�-r Ca c y-el -
#'`' I a 7 I /'�cc. cUti
ADDRESS: S
4-061
CITY 1 STATE 1 ZIP: S LL L
���:•'"'� OFFICE TELEPHONE: 3 FAX: S
j EMAIL: 0 TetiG7 %�OT�^,a,'L Ccs w, �� j��/i �✓Sr�C��rt�C , y%� �iG�
t REGIS 11\ATI®N FEE
Employees of Companies holding a Service Provider membership qualify for the Member rates.
'IV Full conference member* ❑ Advance: $125 ❑ On-site: $185 f• ® '
Full conference non-member* ❑ Advance: $215 ❑ On-site: $265 .''< •, # " - < ., t
One day-member* t-Advance: $100 ❑ On-site: $135 Day:
'M
� One da non-member* ❑ Advance: $195 .❑ On-site: $230 Da
�k
-,•x��i A$10.00 fee will be charged for all on-site name changes on pre-registration name badges.
COMPLIMENTARY REGISTRATIONS
❑ Student,full-time ❑ Retired(AWWA members only) _E,,:;: ,
❑ Guest(Admittance to receptions only) Name:
';jai��t 1 1• 1 .•�V-`
'- EARLY BIRD REGISTRATION
= ;3 Monday, Feb.9, 3:00-7:00 p.m.
�y^q;
MEALS-Tickets required '
At-T-uesday, Feb. 10, 12-noon: Keynote luncheon-$25
;�. . ❑Wednesday, Feb. 11, 12-noon:Awards luncheon-$25 .b ,
❑Thursday,Feb. 12,7:30 a.m.:Breakfast-$15
---------------------------------------------------------------------------------------------------------
+�}..
Total Amount Enclosed:$ 1 � Return`this completed form with payment to the address below or visit www.inawwa.or to register online.
P P Y 9 9
.Check made payable to Indiana Section AWWA is enclosed. (Check no.: )
4k
❑ Please charge to my: ❑Visa ❑ MasterCard ❑American Express ❑ Discover
° Name as it appears on card:
M Billing address:
t. Card number: Exp.date: Signature:
ONLY ONE NAME PER SPECIAL NEEDS REFUND POLICY RETURN COMPLETED
sr r•x.s.
FORM, PLEASE Every reasonable effort will be You can recover your pre-pay- FORM TO:
Photoco the registration made to accommodate special ment by written request, post- Indiana Section AWWA
: > pY g p5265 E.82nd Street
form for use by others needs. Please contact Dawn marked no later than Jan.1,
r. Suite 310
or go to our web site for additional Keyler at(866)213-2796 or 2015,to Dawn Keyler. Indianapolis, IN 46250
- forms or to register online dawn.keyler@inawwa.org Request for refunds made after Office:(866)213-2796
www.inawwa.or9 with request. that date cannot be honored.
FAX:(866)215-5966
0 111'
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107tH Annual Meetin
� . SECTION
YS'�`k Marriott Hotel-Indianapolis,IN
February 10-12,2015
d .r N
U T I L I T Y 1 0 P E R A T 0 R 1 G 0 V E R N H E N T
4N.-EN `^
NAME: C-16JO O Sere A `�
(only one name per form) AWWA MEMBER#: U
w`~`# Last First Initial
3j�;;, TITLE: A'►j J h-c'r Lj S d 2 ORGANIZATION: Gt t1l ®F G fin"
'Vl' ADDRESS: L 3 y 1 (0 W II S •5
CITY 1 STATE I ZIP: C A� g 6 0 7
`i OFFICE TELEPHONE: ( 317 ) 133- S FAX: ( 3'7 ) 73
EMAIL: (o v d C I'm e 6✓
•'s'lt''.Yt
RIEGISTRAMN HES
-4i Employees of Companies holding a Service Provider membership qualify for the Member rates. }..
rx;3 Full conference-member* ❑ Advance: $125 ❑ On-site:$185
`x
Full conference-non-member* ❑ Advance: $215 ❑ On-site: $265 :,•, t.'r= ': =fi t ' ''1` .'.'.
zw ..A One day-member* Advance: $100 ❑ On-site: $135 Day:
One day-non-member* ❑ Advance: $195 ❑ On-site: $230 Day:
'A$10.00 fee will be charged for all on-site name changes on pre-registration name badges.
eT
COMPLIMENTARY REGISTRATIONS
7 ❑ Student,full-time ❑ Retired(AWWA members only) -
�'`? ❑ Guest(Admittance to receptions only) Name: '
EARLY BIRD REGISTRATION
Monday, Feb.9,3:00-7:00 p.m.
MEALS, Tickets required
Tuesday, Feb. 10, 12 noon:Keynote luncheon $25
❑Wednesday, Feb. 11, 12-noon:Awards luncheon-$25 w '
❑Thursday,Feb. 12,7:30 a.m.:Breakfast-$15
or ----- ---------------------------------------------------------------------
T tat Amount Endo'S a.$ i Return this completed form with payment to the address below or visit www.inawwa.org to register online.
' Check made P y�b
e to Indiana Section AWWA is enclosed. Check no.: )
❑ Please charge to my: ❑Visa ❑ MasterCard ❑American Express ❑ Discover
XX.
��� Name as it appears on card:
Billing address:
Card number: Exp.date: Signature:
r. ONLY ONE NAME PER SPECIAL NEEDS REFUND POLICY RETURN COMPLETED
FORM, PLEASE Every reasonable effort will be You can recover your pre-pay- FORM TO:
Indiana Section AWWA
a Photocopy the registration made to accommodate special ment by written request,post-
5265 E. 82nd Street
form for use by others needs. Please contact Dawn marked no later than Jan.1,
•�.: :;: Suite 310
Y' or go to our web site for additional Keyler at(866)213-2796 or 2015,to Dawn Keyler.
Indianapolis, IN 46250
forms or to register online dawn.keyler@inawwa.org Request for refunds made after Office: 866 213-2796
www.inawwa.org with your request. that date cannot be honored. FAX:(866)215-5966
fes'
„...
107th Annual MeetinM MASECOHON AWWAg
'. Marriott Hotel—Indianapolis,IN
February 10-12,2015
U T I L I T Y 1 0 P E R A T 0 R / G 0 V E R N H E N T
F
NAME: A n o,;f � (only one name perform)
AWWA MEMBER#: t) a 17
Last First Initial
-2 TITLE: �✓txktt 0q a�u•r ORGANIZATION: Ls�y o� �ar✓��`
,�i'I
ADDRESS: `1 SU V✓, 131 S.t
sr CITY I STATE 1 ZIP: C.-0, L(
OFFICE TELEPHONE: (�_) 1 J ' Z FAX: ( -3)- ) 113 ”ZaS3
<;• 41
EMAIL: 1LQv,ti,:f Cc rw.el ScJ. �uiJ
•a4': ^Y
REGISTRATION FEES. r :.
Employees of Companies holding a Service Provider membership qualify,for the Member rates.
Full conference-member* ❑ Advance: $125 ❑ On-site:$185 ° 4
Full conference non-member* ❑ Advance: $215 ❑ On-site:$265
'csY;K "T�es�a�, Feb 10
nllx4 One day-member* ,Advance: $100 ❑ On-site:$135 Day:
One day-non-member* ❑ Advance: $195 .❑ On-site:$230 Day: .3
a ? *A$10.00 fee will be charged for all on-site name changes on pre-registration name badges.
.;". COMPLIMENTARY REGISTRATIONS
❑ Student,full-time ❑ Retired(AWWA members only) ,:: .� .� _, ., ;,.; ;;r ,r:, r:. :fi• .:,.F�
❑ Guest(Admittance to receptions only) Name:
EARLY BIRD REGISTRATION
�, a..I T 1 1 1• 1 _
"• Monday, Feb. 9,3:00 7:00 p.m.
:' °I MEALS Tickets required '-
" 'L� XTuesday, Feb. 10, 12-noon: Keynote luncheon-$25
;' c? ❑Wednesday, Feb. 11, 12-noon:Awards luncheon-$25 '
❑Thursday,Feb. 12,7:30 a.m.:Breakfast $15
: ----------------:------------------------------p- ---------------------------------------g- - -------
Total Amount Enclosed.$ Z - Return this completed form with payment to the address below or visit www.inawwa.or to register online.
Check made payable to Indiana Section AWWA is enclosed. (Check no.: )
s° ❑ Please charge to my: ❑Visa ❑ MasterCard ❑American Express ❑ Discover
Name as it appears on card:
:4yQ Billing address:
;. Card number: Exp.date: Signature:
r ONLY ONE NAME PER SPECIAL NEEDS REFUND POLICY RETURN COMPLETED
FORM,PLEASE Every reasonable effort will be You can recover your pre-pay- FORM TO:
:•=,JJ Indiana Section AWWA
Photocopy the registration made to accommodate special ment by written request,post-
5265 E.82nd Street
form for use by others needs. Please contact Dawn marked no later than Jan.1, Suite 310
^' ; or go to our web site for additional Keyler at(866) 213 2796 or 2015,to Dawn Keyler.
* " Indianapolis, IN 46250
forms or to register online dawn.keyler@inawwa.org Request for refunds made after Office: (866)213-2796
f=; www.inawwa.org with your request. that date cannot be honored. FAX: (866)215-5966
�^.Y h•t Yy
�r .Y r''v-'.. '".r"rte,'r1,r°.r,. ,.x "k r=,d•''.moi :Y .�`" S'= _L �� -' y
' - 107th Annual MeetinMMA g
_ 'r'y�+��r�-rrrp��� I�Ir��QQI'�f�I�
1 .t SEC(J QGf �b Y
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AWWA
Marriott Motel—Indianapolis,IN
Febniary 10-12,2015
U T I L I T Y 1 0 P E R A T 0 R ! G 0 V E R N M E N T
' NAME: C
r�s11 to drew R (only one name perform) AWWA MEMBER#: t4" L.
Lasl First Initial
'r TITLE: el ®/Nro46i ORGANIZATION: C'Y ✓ of r,n.e
ADDRESS: Yf!M W 131 l}
CITY 1 STATE 1 ZIP: Carme 1 7W
ski i'
OFFICE TELEPHONE: (-?/7 ) 733 '2,9rS- FAX: ( 317 ) 733 — 2053
r EMAIL: 4Cr+s/ Ccrrmef m . 9O✓
.:t. „ REGISTRATION FEESX
^' Employees of Companies holding a Service Provider membership qualify for the Member rates.
r r Full conference-member* ElAdvance: $125 El On-site: $185
t.;.•L,
Full conference-non-member ❑ Advance: $215 ❑ On-site: $265
o rf One day-member* * ,C Advance: $100 ❑ On-site: $135 Day: /�Ps� �C 6 10
One day-non-member ❑ Advance: $195 .❑ On site: $230 Day: '
*A$10.00 fee will be charged for all on-site name changes on pre-registration name badges.
CONPLIMENTARY REGISTRATIONS
❑ Student,full-time [3 Retired (AWWA members only) Y , �•
.� ❑ Guest(Admittance to receptions only) Name: '
`_
?' EARLY BIRD REGISTRATION
i1 Monday, Feb.9, 3:00-7:00 p.m. -
';5N-1 —Tickets required
VCTuesday, Feb. 10, 12-noon: Keynote luncheon-$25
❑Wednesday, Feb. 11, 12-noon:Awards luncheon-$25
❑Thursday,Feb. 12, 7:30 a.m.:Breakfast-$15
---------------------------------------------------------------------------------------------------------
Total Amount Enclosed:� � P payment 9 9
�Z� Return this completed form with a ment to the address below or visit www.inawwa.or to register online. i
heck made payable to Indiana Section AWWA is enclosed. Check no.:
❑ Please charge to my: ❑Visa ❑ MasterCard ❑American Express ❑ Discover
::. Name as it appears on card:
Billing address:
v Card number: Exp.date: Signature:
ONLY ONE NAME PER SPECIAL NEEDS REFUND POLICY RETURN COMPLETED
FORM,PLEASE Every reasonable effort will be You can recover your pre-pay- FORM TO:
Photocopy the registration made to accommodate special ment by written request, post- Indiana Section AWWA
s ,= form for use by others needs. Please contact Dawn marked no later than Jan.1,
5265 E. 82nd Street
or go to our web site for additional Keyler at(866)213-2796 or 2015,to Dawn Keyler.
Suite 310
tom,. Indianapolis, IN 46250
,..�- forms or to register online dawn.keyler@inawwa.org Request for refunds made after Office: (866)213-2796
' .' www.inawwa.org with your request. that date cannot be honored. FAX: (866)215-5966
107th Annual Meetin8
MMA SECTION AWWA
Marriott Hotel-Indianapolis,IN
February 10-12,2015
R E G ez"I T R A T 1 0 N F 0
U T I L I T Y 1 0 P E R A T 0 R I G 0 V E R N M E N T
NAME: VLA C'C 5 , e 7�' (only one name per form) AWWA MEMBER#: (`�O 3 (4 Z 4(p
Last First Initial
TITLE: VVakec OReca-4�o,A5 a. -4�,k ORGANIZATION:
ADDRESS: 4Sp W, l3\s�' Sk.
CITY I STATE I ZIP: C ac inn e\ I tJ 4(PC-14
OFFICE TELEPHONE: ( 3 11 ) 13 3- Z S SS FAX: ( 31-1 )
EMAIL: d2 L-- e-C5 C, Gd�rvtie \ to
REGISTRATION FEES ;.
Employees of Companies holding a Service Provider membership qualify for the Member rates. o o . D
Full conference-member* Advance: $125 ❑ On-site: $185
Full conference-non-member* ❑ Advance: $215 ❑ On-site: $265
One day-member* ❑ Advance: $100 ❑ On-site: $135 Day.
One day-non-member* ❑ Advance: $195 ❑ On-site: $230 Day: De
*A$10.00 fee will be charged for all on-site name changes on pre-registration name badges.
COMPLIMENTARY REGISTRATIONS
�<- = ❑ Student,full-time ❑ Retired(AWWA members only)
❑ Guest(Admittance to receptions only) Name:
EARLY BIRD REGISTRATION
Monday, Feb. 9,3:00-7:00 p.m. .
19LS—Tickets required °
ff!psday, Feb. 10, 12-noon: Keynote luncheon-$25
NMednesday, Feb. 11, 12-noon:Awards luncheon-$25 '
❑Thursday, Feb. 12,7:30 a.m.:Breakfast-$15
---------------------------------------------------------------------------------------------------------
ToW Amount Enclosed:$ I—15- r Return this completed form with payment to the address below or visit www.inawwa.org to register online.
heck made payable to Indiana Section AWWA is enclosed. (Check no.: )
❑ Please charge to my: ❑Visa ❑ MasterCard ❑American Express ❑ Discover
Name as it appears on card:
Billing address:
Card number: Exp. date: Signature:
ONLY ONE NAME PER SPECIAL NEEDS REFUND POLICY RETURN COMPLETED
FORM,PLEASE! Every reasonable effort will be You can recover your pre-pay- FORM TO:
Photocopy the registration made to accommodate special ment by written request, post- Indiana Section AWWA
form for use by others needs. Please contact Dawn marked no later than Jan.1, 5265 E.82nd Street
or o to our web site for additional Ke ler at 866 213-2796 or 2015,to Dawn Keyler. Suite 310
g Y ( ) Indianapolis, IN 46250
forms or to register online dawn.keyler@inawwa.org Request for refunds made after Office:(866)213-2796
www.inawwa.org with your request. that date cannot be honored. FAX:(866)215-5966