Free Regis. Form

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The pre-registration deadline is Friday, June 5, 2009, because we need a head-count to order the right amount of beverages and food.

To submit your free registration form, please complete ALL the information requested below, and then click the Submit Form button at the bottom of this page.

To qualify for a free registration, you must be an employee or member of any federal, state, or local government agency or entity,  a Master Well Owner, or a teacher or student.  Regional Committee members and Statewide Committee members also qualify for free registration.  Commission and authority members and employees also qualify for free registration.

We have received a grant from the West Penn Power Sustainable Energy Fund, through its PA Home Energy program, for 25 FREE registrations for the general public to attend this event.

To take advantage of a free registration from the West Penn Power Sustainable Energy Fund (WPPSEF), fill out the form below and put "WPPSEF" in the box for "Organization".  Please complete the entire form, including the check boxes and circles, and then submit your FREE registration by clicking on the "Submit Form" button.

Please provide the following contact information to qualify for a free registration:

Name:   
Title:   
Organization:   
Work Phone:   
E-mail:  

Note:  We need your e-mail address so we can send a registration confirmation to you.

We will not release your e-mail address.  If you do not have e-mail, please place your fax number in the e-mail field.

Please check the appropriate boxes below so we will provide enough meals.

       I will attend on Friday, June 12, 2009 and plan to eat the lunch catered by Clem's Barbeque.

       I plan to attend the General Membership meeting.

Please tell us how you heard about the PGWA Summer Field Conference by clicking a button:

E-Mail from within my agency or organization

A colleague or co-worker told me

Pennsylvania Driller Newsletter

This Web site

The League of Women Voter's Public Forum

Clicking the Submit Form button will display the data you have entered above, and will send this Free Registration Form to Rose Ann Hoover of the Pennsylvania Ground Water Association.  If you need to contact Rose Ann Hoover by e-mail click this link, or call her at (814) 933-8714.

Pennsylvania Ground Water Association.  Copyright © 2005[PGWA]. All rights reserved.
Revised: 07/23/09
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Last modified: September 15, 2009.