AMTA Workshop RegistrationYankton, SD | August 13, 2020 Membranes Meeting Water Quality Issues in the Mid-West Yankton, SDThursday, August 13, 2020 RegistrantSalutation*Mr.Mrs.Ms.Dr.First Name* Middle Initial Last Name* Job Title* Company* Address* City* State*Not Applicable, InternationalAKAZARCACOCTDCDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYZip* Country*AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUSAUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwePhone* Cell Email* Website Special Needs Food Allergies (describe below) Gluten Free Meals Vegan Meals Vegetarian Meals Wheelchair Access Other (describe below) Special Needs Comments HiddenMember AMTA NWMOA SEDA SCMA SWMOA IDA (check all that apply) Billing Contact InformationEnter billing contact information, if applicableBilling Contact Name Billing Contact EmailEnter billing contact's email address, if applicable Billing Contact Phone Please send copy of the invoice/receipt to Billing Contact HiddenStaying at Host HotelMake hotel arrangements directly with the Hotel Name by clicking the link provided or by phone at ___-___-____. Refer to AMTA for the discounted room rate. Book by Date and save!HiddenWill you be staying at the Host Hotel* Staying at the host hotel Not staying at the host hotel HiddenHow many nights will you be staying at the Host Hotel* Workshop RegistrationDiscount rates apply to registrations that are paid in full by July 30th. To Sponsor/Exhibit click option below. To register as an Attendee, click No Sponsorship and No Exhibit and select appropriate Registration option under Workshop Attendee Discount Rates.HiddenWorkshop RegistrationTo Sponsor/Exhibit click option below. To register as an Attendee, click No Sponsorship and No Exhibit and select appropriate Registration option under Workshop Attendee.HiddenToday - Date MM slash DD slash YYYY Event Sponsor Details Show Sponsorship Details Major: $1,000 Includes One Registration Recognition as Major Sponsor Lunch: $500 Recognition as Lunch Sponsor Refreshment Break: $250 Recognition as Refreshment Break Sponsor Event Sponsor* Major Sponsor, $1,000 Lunch Sponsor, $500 Refreshment Break Sponsor, $250 No Sponsorship HiddenExhibit Space* Table Top Exhibit, $750 No Exhibit One full attendee registration included in Exhibitor Package.Spaces are selected onsite - first come, first served.Must be a Div 1 (Utility) or Div 2 (Corporate) member to exhibit. Select the provided links for more information on types of AMTA MembershipCompany Description*100-word company descriptionUpload Company Logoplease provide a High Resolution, 300 DPI or greater Drop files here or Select files Max. file size: 32 MB. Included Attendee?* I will be the Attendee Send a Registration Link, another person will be attending Speaker/Moderator? Speaker Moderator Workshop Attendee Discount Rates*If not a member, Join AMTA Now, for Member Discounted Rates AMTA Member, $150 Non-Member, $250 Non-Attendee - Purchase Materials Only, $30 Speaker/Moderator Workshop Attendee Discount Rates*If not a member, Join AMTA Now, for Member Discounted Rates AMTA Member, $75 Non-Member, $125 Workshop Attendee*If not a member, Join AMTA Now, for Member Discounted Rates AMTA Member, $250 Non-Member, $350 Non-Attendee - Purchase Materials Only, $30 Speaker/Moderator Workshop Attendee*If not a member, Join AMTA Now, for Member Discounted Rates AMTA Member, $125 Non-Member, $175 Workshop ActivitiesPlant Tour*Thurs., August 13th - 3:00-4:00pm Attending Plant Tour Not Attending Plant Tour HiddenNetworking Reception*Thurs., August 13th - 4:30-6:00pm Attending Networking Reception Not Attending Networking Reception HiddenGuest/Spouse Networking Reception*Thurs., August 13th - 4:30-6:00pm Guest Attending Networking Reception, $10 Guest Not Attending Networking Reception HiddenHow Many Attending?*123456HiddenGuest Name* First Last Need Contact Hours Certification?* Yes, need contact hours certification No contact hours required Included with registration fee.License #* License State* License Type* License Class* Total FeeTotal $0.00 Payment InformationDue to the COVID-19 Pandemic, registration payments will be processed after May 15th. Please select Invoice if you would like to pay by Credit Card. After May 15th, an email will be sent with a link for you to enter your credit card for payment processing.Payment Method* Invoice Check Mail check made payable to: American Membrane Technology Association PO Box 14918., Tallahassee, FL 32317 Comments & CAPTCHACommentsCAPTCHA Cancellations and RefundsWritten cancellation requests received by AMTA on or before July 30, 2020 will receive a refund, less a $50 processing fee. Full payment is required if cancellation is received on or after July 31, 2020 no refunds and no credits for future events will be granted. However, substitutions may be made at any time. AMTA 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, AMTA’s liability is limited to the refund of the program fee only. 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