TRAINING REGISTRATION FORM

Please provide the following contact information:

First Name
Last Name
Title
Community/Firm
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Work Phone
FAX
E-mail
Web Address
Training Class
Date of Class

Choose one of the following options:

Invoice Me Payment Mailed                           Class Fee:  

Please Mail Payments To:

Michigan Rural Water Association

PO Box 960

Harrison, MI 48625