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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.

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