SCMA Workshop Included Comp. Registration – June 12 Wednesday, June 12, 2019 | 7:30 a.m. - 5:15 p.m. (Space limited to 50 attendees)RO Operations & Maintenance WorkshopAransas Pass Civic Center | Aransas Pass, TX RegistrantSalutation*Mr.Mrs.Ms.Dr.First Name*Last Name*Job Title*Company*Address*City*State*Zip/Postal Code*Country*Phone*CellEmail*Enter registered attendee's email address Website Special Needs Food Allergies (describe in comments) Gluten Free Meals Halal Meals Paleo Meals Vegan Meals Vegetarian Meals Wheelchair Access Other (describe in Comments) Billing Contact InformationEnter billing contact information, if applicableBilling Contact Name First Last Billing Contact Email Billing Contact Phone Communication and Data Sharing PreferenceEmails about SCMA/Affiliate Events, Newsletters, and/or Upcoming Activities are welcome*YesNoAuthorization for receiving publication email notification from SCMA.(applies to all email addresses on this form)Networking with other SCMA Members, Operators, Attendees, Speakers, Moderators, Sponsors, Board Members, and others interested with membranes is approved, share my contact information (cell phone # will not be included)*YesNo Workshop Registration$50 discount if choose both WorkshopsToday Date Date Format: MM slash DD slash YYYY June 12th RO Workshop Registration*Comp. Reg. for Sponsor (already purchased), $0Comp. Reg. for Host Facility, $0For other types of membership - please contact SCMA for membership application, or click here to apply for membership now. * Div.1B* SCMA membership contingent on existing Primary Member Contact Hours*Yes, need contact hours certificationNo contact hours requiredincluded in registration feeLicense #*License State*License Type*License Grade* Total Registration Fee $0.00 Payment InformationPayment Method*Complimentary Registration Only - No Optional Items SelectedCredit Card - Online PaymenteCheck (Bank Wire w/o processing fee) - Online PaymentCheckInvoiceIf paying by check, make payable to: South Central Membrane Association, and mail to: 14900 Avery Ranch Blvd., Ste. C200 #300, Austin, TX 78717. CommentsIf you would like a copy of the invoice/receipt sent to another*Yes, send copy of invoice/receipt to:No, don't need a copy sentName* First Last If yes, you would like a copy of the invoice/receipt sent to another other than the attendee please enter information.Email Address* If yes, you would like a copy of the invoice/receipt sent to another other than the attendee please enter information. Comments or Instructions Written cancellation requests received on or before May 29, 2019 will receive a refund, less a $50 processing fee. Full payment is required if cancellation is received on or after May 30, 2019 - no refunds and no credits for future events will be granted. However, substitutions may be made at any time. SCMA reserves the right to make changes in programs and speakers, or to cancel programs when conditions beyond its control prevail. Every effort will be made to contact each enrollee if a program is cancelled. If a program is not held, SCMA’s liability is limited to the refund of the program fee only. Final Step of Application ProcessCAPTCHAPlease enter the letters displayed above to complete your application and then click Submit.PhoneThis field is for validation purposes and should be left unchanged.