Application
Content
Georgia Water & Wastewater Institute
511 Stadium Drive Carrollton, GA 30117 Phone 770.214.0153 / Fax 770.214.0219
GWWI COURSE REGISTRATION
Please Type or Print Clearly
First Name: Social Security #: Employer: Supervisor's Name: Work Address: City: Home Address: City: Work Phone: Fax Number: Course Name:
M.I.
Last Name:
(last 4 digits - for internal student tracking purposes only)
State:
Zip:
State: Home or Mobile Phone: e-mail:
Zip:
Course Date:
If you wish to pay by Credit Card, complete this section or call the secretary to provide this information by phone. Card: Card #:
Visa / MC / AMEX
Name as it appears on card: Exp. Date: Sec. Code:
Registration - To register, complete registration form and return with payment (check or credit card) to the listed address. Pre-registration is required and payment is due prior to the beginning of the course. You may also register by credit card online at www.gwwi.org. Cancellation - Cancellations must be received at least two weeks prior to the start of the course in order to receive a full refund. Cancellations received at least one week prior to the start of the course will be eligible to receive only a 50% refund. We will be unable to provide refunds for cancellations received less than one week prior to the course. Locations - All classes are held at the GWWI facility in Carrollton, Georgia, unless otherwise noted on the course schedule. Course dates and locations are subject to change. Class sizes are limited.
511 Stadium Drive Carrollton, GA 30117 Phone 770.214.0153 / Fax 770.214.0219
GWWI COURSE REGISTRATION
Please Type or Print Clearly
First Name: Social Security #: Employer: Supervisor's Name: Work Address: City: Home Address: City: Work Phone: Fax Number: Course Name:
M.I.
Last Name:
(last 4 digits - for internal student tracking purposes only)
State:
Zip:
State: Home or Mobile Phone: e-mail:
Zip:
Course Date:
If you wish to pay by Credit Card, complete this section or call the secretary to provide this information by phone. Card: Card #:
Visa / MC / AMEX
Name as it appears on card: Exp. Date: Sec. Code:
Registration - To register, complete registration form and return with payment (check or credit card) to the listed address. Pre-registration is required and payment is due prior to the beginning of the course. You may also register by credit card online at www.gwwi.org. Cancellation - Cancellations must be received at least two weeks prior to the start of the course in order to receive a full refund. Cancellations received at least one week prior to the start of the course will be eligible to receive only a 50% refund. We will be unable to provide refunds for cancellations received less than one week prior to the course. Locations - All classes are held at the GWWI facility in Carrollton, Georgia, unless otherwise noted on the course schedule. Course dates and locations are subject to change. Class sizes are limited.
