2009 AWBD Mid Winter Conference
Comprehensive Registration Form

Friday, January 23 - Saturday, January 24
Hilton Hotel
Austin, Texas

To register, complete the registration and emergency data forms below. This registration is for a delegate and one guest only.
Indicate the events you or your guest will attend.

• Registrations received no later than the close of business December 11, 2008 will be charged at the rate of $265.00 for members and $530.00 for non-members.
• A $50.00 administrative fee is assessed for each conference registration canceled on or before December 11, 2008.
• There will be no refunds after December 11, 2008.
• Registrations made after December 11, 2008 will be charged at the rate of $315.00 for members and $630.00 for non-members.
• Any registrations received after December 30, 2008 are subject to a late fee of $100.00 per registration and do not guarantee the registrant seating at food function nor receipt of conference material or hospitality items.
• All registrations are non-transferable.

The fields marked with a * are required. Your information will not be submitted until you click the "Submit" button at the bottom of the page. The office will send your registration confirmation directly to you. Check it when you receive it and notify the office at once if there is an error. If registration confirmation is not received in a timely manner, contact the AWBD office directly. If you need any assistance please call Taylor at 281/350-7090 or e-mail tcavnar@awbd-tx.org.

Delegate Name
First:		Last:
Spouse/Guest Name
First:		Last:
Delegate Information
District:
Billing Address:
City:		County:
State:		Zip:	(ZIP Code (5 digits))
Daytime Phone:	(xxx-xxx-xxxx)	Email:	(Email@email.com)
1. MID WINTER CONFERENCE REGISTRATION
Conference:	Member $265/member before Dec 11, 2008 Non-member $530/non-member before Dec 11, 2008
2. MID WINTER CONFERENCE WELCOMING RECEPTION Friday evening, January 23
Reception:	My guest and I will attend I will attend I will not attend
3. CONTINENTAL BREAKFAST - Delegates Only Saturday, January 24
Breakfast:	I will attend I will not attend
4. MID WINTER CONFERENCE LUNCHEON - DELEGATES ONLY Saturday, January 24 DELEGATES ONLY WITH BADGE & TICKET
Lunch:	I will attend I will not attend
5. MID WINTER CONFERENCE SOCIAL RECEPTION Dinner/Dance Saturday, January 24 7:30 - 10:30 p.m.
Social:	My guest and I will attend I will attend I will not attend
No children allowed
No Children
	I understand that there are no children under the age of 21 allowed in the conference area
AWBD Event Hold Harmless Agreement
Hold Harmless:
	As part of the consideration for registration and for participation in the Association of Water Board Directors - Texas Mid Winter Conference (the "Conference"), I warrant and represent that I am in the physical condition necessary to participate in the Conference, I further agree to indemnify and hold harmless AWBD and each of its trustees, officers, employees, committee members and volunteers with respect to any personal injury or death or any property loss or damage suffered or caused as a result of my participation in the Conference, specifically, any injury, death or damage due to the negligence of AWBD, its trustees, officers, employees, committee members and volunteers.
Total Registration Fee:
AWBD Emergency Data Form
Delegate Name - First:		Last:
Street:		City:
State:		Zip:	(ZIP Code (5 digits))
District:
Street:		City:
State:		Zip:	(ZIP Code (5 digits))
Where are you staying during the conference?
Hotel:		Room:
Phone:	(xxx-xxx-xxxx)
In the Event of an Emergency, Please Notify
First:		Last:
Phone:	(xxx-xxx-xxxx)
Street:		City:
State:		Zip:	(ZIP Code (5 digits))
Relationship:
In the Event that Person cannot be Reached, Who Should Be Contacted?
First:		Last:
Phone:	(xxx-xxx-xxxx)
Street:		City:
State:		Zip:	(ZIP Code (5 digits))
Physician
Name:		Phone:	(xxx-xxx-xxxx)
Street:		City:
State:		Zip:	(ZIP Code (5 digits))
Medical Information
Are you Allergic to any type of medication> : Check if YES. If YES, please give type or details
Details:
Do you have any special physical conditions that might create illness? (e.g. diabetes, heart condition, pacemaker, etc.)
Condition:
NOTE: This information is kept confidential and is used for your protection only. This form will be discarded after the conference.
Registration date:	Sunday, October 12, 2008
You have not submitted the form until you have completely filled out this form including the required fields (marked with a *) and clicked the "Submit" button below. When the form is filled out correctly, click the "Submit" button and the confirmation page will be displayed.