Convention ATTENDEE Registration Form 2023 2023 Convention Orlando, FL (Attendee) "*" indicates required fields Step 1 of 4 - FWQA Membership 25% FWQA MembershipAre you a member of FWQA?* Yes No Please Pick Your FWQA Membership*-- select a Member --3Waters FL LLCA-2-Z Water Systems IncAbsolute Water Management - EcoWaterAction Manufacturing & SupplyAdvance Water Systems IncAdvanced Water ProductsAdvanced Water Systems, Inc.Advanced Water Technologies IncAerus LLCAffordable CondtionersAffordable WaterAffordable Water & Coffee ServiceAL Water Treatment Installation, LLCAlbert Soft WaterAll American Purification LLCAll Florida Soft WaterAll Star Plumbing & DrainAll-Rite Water PurificationAllini Water Filters of FloridaAO Smith Water Treatment (NA) Inc, Hague Quality WaterAQMaticAqua Care Water Treatment & PlumbingAqua FinanceAqua Guru , LLCAqua Plumbing & Air Services IncAQUA SOFT REFINED WATER INC.Aqua SolutionsAqua WholesaleAquaflow LLCAquakleen Products IncAquamundoAquasun LLCAqueous Solutions GlobalArrow Industries Division of Elbi of AmericaArt Plumbing, AC & ElectricAshberry Water ConditioningAtlantic Filter CorpAtlantic Filter of Polk CountyAtlantis Filter LLCAvoda Water SolutionsBalanced Water and Drain ServicesBest Water Solutions, Inc.Bluewater USA, IncBrita ProBush Services Inc.C-Tech Water SolutionsCaptain FiltrationCargill SaltCastle Credit Co Holdings, LLCCertain Services IncCGC Water -/ Northeast Florida Water LLCCharger Water Treatment - JacksonvilleCharger Water Treatment - OdessaChowder FinancialClack CorporationClean Water AmericaCLEAR WATER TREATMENTClearwater SoftenersCoast Pump Water TechnologiesCoastal Energy Water & Air- Rainsoft Distributor EastCoastal Energy Water & Air- Rainsoft Distributor WestComplete Water SystemsCon-Serv Mfg.Crystal Clear Water Purification IncCRYSTAL WATER SYSTEMS INCCulligan Melbourne/ Daytona BeachCulligan Water Ft. MyersCulligan Water Services - Kingsland GADarrel's PlumbingDataman Group DirectDiscount Water SupplyDOMERS INCDyco WaterEast Coast Well, Pump & Water TreatmentEcoWater of North Florida/ Sunshine State Water LLCEcoWater of TampaEd's Wells & Pumps IncEnpress LLCEnvironmental World Products LLCEvergaldes Laboratories, IncFargo Well and Pump Services IncFCT Water FloridaFilter Pure Systems, Inc.Filter Pure Systems, Inc.Filtration PartsFinal Filter LLCFlorida Pump ServiceFlorida Water Consultants, LLCFlorida Water TechnologiesFloTrol International LLCFluid Systems and ControlsFoundation FinanceFritton Water IncFSHSG.A. MURDOCKGenesis Environmental Tecnologies, Inc/ Tri Star Marketing and Distributing LLCGet Water AnswersGetWaterAnswers.comGlobematicGolden Gate Well DrillingGood Marketing GroupGorman Company/ HajocaGrid Controls LLCGuardian Water ServicesGulf Coast Water Conditioning IncGW Pumps & PurificationH2O Florida LLCH2O InternationalH2O Systems IncH2O Water ProsHarrington Industrial PlasticsHealthy Water Systems, LLCHome Supply & Services LLCHydrenesis, IncHydro Medix Technologies Inc.Hydrotech-A division of Canature WaterGroupIG Water Treatment InternationalIntegrity Water Treatment LLCITZGOOD H2O HEALTHY SOLUTIONSJ.C. GALLOWAY, THE WATER DOCTOR, INC.Jax Water Conditioning IncJB Water TreatmentJohn Guest USA/ RWCK & R Water Service IncKenai CollectionKey Salt and WaterKineticoKinetico water systems of SW FLLamplight Digital Media, LLCLand O Lakes ( Crocker Water)Leaf Home Water SolutionsLiquid Soap ProductsMiami Alkaline WaterMJHS, LLCMorton SaltMr. Rooter PlumbingMr.Water CompanyMy Innovation Products,LLCNelsen CorpNew Wave WaterNorth South Supply IncNothing But WaterNuco Pump & Well Services LLCPalm Beach Water PurificationPentair WaterPhase 2 Smart Water SolutionsPinnacle Express, IncPortasoft WaterPrecision Installation Products IncPremier Water PurificationPro ProductsPure and Gentle SoapPURE FLOW WATER PRODUCTSPure Liquid Water, LLCPure Touch Water Filters IncPuronics Water Systems, IncQuantum Leap Sales Meetings & Training LLCR & S Softwater Service IncReps H2OResinTechSafeway Water LLCSayler's Suncoast WaterScotwood Industries LLCSeamans Aqua CleanSeminole Tribe of FloridaSensible Water Solutions LLCSheffield's Pump Service LLCSilver King Water TreatmentSimpleWater Inc.Simply Soft WaterSonomo County SoapSouthern Water Services IncStenner Pump CompanySundial Inc.SWFL Hydrology IncT & K Water ConditioningTHE LEVEREDGEThe Water ExpoThermaxUnited DistributorsVery Well Water LLCVIP Water Filtration and IrrigationVolteaWater ExpertsWater Genius Systems IncWater Medic of Cape Coral, Inc.Water Technology ResourcesWater Treatment and Filtration LLCWater Treatment WarehouseWater-ProWATER-RIGHT, INC.WaterColor ManagementWaterite – Franklin Water TreatmentWaterman CompanyWaterTech IncWATTSWest Coast Plumbing & Water Treatment LLCXcell Water ConditioningWould you like become a member of FWQA and save on today's registration?**An FWQA membership is $175 and will be added to today's total. The membership includes more than a 25% discount off of the registration rate for the FWQA Convention, among other benefits YES! Please add membership and start saving now No thank you. FWQA Membership InformationName* First Last Email* Phone*Company* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Total Member Attendee RegistrationIs the primary FWQA Member attending? Yes No Is the primary FWQA Member you just registered attending? Yes No Primary FWQA Member Name* First Last Primary FWQA Member Email* Primary FWQA Member Phone*Member FULL Registration ($125)*Includes one (1) badge for Hospitality Event, Educational Seminars, Lunch On Thursday, and Trade Show (Thursday and Friday) Yes, Add Member FULL Registration No member FULL Registration Would You Like to Add Additional FULL Registrations?*$60 Each. Includes additional badge(s) for Hospitality Event, Educational Seminars, Lunch On Thursday, and Trade Show (Thursday and Friday) for employees, spouses, etc. No Additional Attendees Needed Yes, Please Add Additional Attendees How Many Additional FULL Registrations? Quantity*Additional badge(s) for Hospitality Event, Educational Seminars, Lunch On Thursday, and Trade Show (Thursday and Friday) for employees, spouses, etc. Price: $60.00 Quantity Your Additional FULL Registrations Info:*Please add a row by clicking the (+) at the end of each row. YOU MUST register EACH Additional FULL Attendee you are requesting with name and email.NameEmail Add RemoveMember EXHIBITS ONLY Registration ($75 ea.)*Each Badge Includes one (1) badge for THURSDAY (12:30 pm -4:30pm ) & FRIDAY (9:00 am-11:00 am) Trade Show Floor Only. Yes, Add Member EXHIBITS ONLY Registration(s) No member EXHIBITS ONLY Registrations How Many Additional EXHIBITS ONLY Registrations? Quantity*Additional badge(s) for Hospitality Event, Educational Seminars, Lunch On Thursday, and Trade Show (Thursday and Friday) for employees, spouses, etc. Price: $75.00 Quantity Your Additional EXHIBITS ONLY Registrations Info:*Please add a row by clicking the (+) at the end of each row. YOU MUST register EACH Additional EXHIBITS ONLY Attendee you are requesting with name and email.NameEmail Add RemoveHOSPITALITY EVENT Thursday evening NOTE: The Hospitality Event is INCLUDED with FULL REGISTRATION(S) You ONLY need to register ADDITIONAL GUESTS.Member HOSPITALITY ONLY* Registration ($75 ea.)**INCLUDED with FULL REGISTRATION(S) Hospitality event Thursday evening (Included with Full Registration) Yes, Add Member HOSPITALITY ONLY Registration(s) No member HOSPITALITY ONLY Registrations How Many Additional HOSPITALITY ONLY* Registrations? Quantity**INCLUDED with FULL REGISTRATION(S) Hospitality event Thursday evening (Included with Full Registration) for employees, spouses, etc. Price: $75.00 Quantity Your Additional HOSPITALITY ONLY Registrations Info:*Please add a row by clicking the (+) at the end of each row. YOU MUST register EACH Additional HOSPITALITY Attendee you are requesting with name and email.NameEmail Add RemoveTotal Non-Member Attendee RegistrationNon Member (NM) FULL Registration ($175)*Includes one (1) badge for Hospitality Event, Educational Seminars, Lunch On Thursday, and Trade Show (Thursday and Friday) Yes, Add Non-Member FULL Registration No non-member FULL Registration Would You Like to Add Additional FULL NM Registrations?*$175 Each. Includes additional badge(s) for Hospitality Event, Educational Seminars, Lunch On Thursday, and Trade Show (Thursday and Friday) for employees, spouses, etc. No Additional Attendees Needed Yes, Please Add Additional Attendees How Many Additional FULL NM Registrations? Quantity*Additional badge(s) for Hospitality Event, Educational Seminars, Lunch On Thursday, and Trade Show (Thursday and Friday) for employees, spouses, etc. Price: $175.00 Quantity Your Additional FULL NM Registrations Info:*Please add a row by clicking the (+) at the end of each row. YOU MUST register EACH Additional FULL Attendee you are requesting with name and email.NameEmail Add RemoveNon-Member (NM) EXHIBITS ONLY Registration ($100 ea.)*Each Badge Includes one (1) badge for THURSDAY (12:30 pm -4:30pm ) & FRIDAY (9:00 am-11:00 am) Trade Show Floor Only. Yes, Add Non Member EXHIBITS ONLY Registration(s) No non member EXHIBITS ONLY Registrations How Many Additional NM EXHIBITS ONLY Registrations? Quantity*Additional badge(s) for Hospitality Event, Educational Seminars, Lunch On Thursday, and Trade Show (Thursday and Friday) for employees, spouses, etc. Price: $100.00 Quantity Your Additional NM EXHIBITS ONLY Registrations Info:*Please add a row by clicking the (+) at the end of each row. YOU MUST register EACH Additional EXHIBITS ONLY Attendee you are requesting with name and email.NameEmail Add RemoveHOSPITALITY EVENT Thursday evening NOTE: The Hospitality Event is INCLUDED with FULL REGISTRATION(S) You ONLY need to register ADDITIONAL GUESTS.Non-Member (NM) HOSPITALITY ONLY* Registration ($150 ea.)**INCLUDED with FULL REGISTRATION(S) Hospitality event Thursday evening (Included with Full Registration) Yes, Add Non-Member HOSPITALITY ONLY Registration(s) No Non-Member HOSPITALITY ONLY Registrations How Many Additional NM HOSPITALITY ONLY* Registrations? Quantity**INCLUDED with FULL REGISTRATION(S) Hospitality event Thursday evening (Included with Full Registration) for employees, spouses, etc. Price: $150.00 Quantity Your Additional NM HOSPITALITY ONLY Registrations Info:*Please add a row by clicking the (+) at the end of each row. YOU MUST register EACH Additional HOSPITALITY Attendee you are requesting with name and email.NameEmail Add RemoveTotal ATTENDEE INFORMATIONPrimary Attendee Registration InformationPlease give us the Name of the Primary AttendeeAttendee is Primary FWQA MemberName* First Last Email* Phone*Total DonationWould you like to donate to the Florida Committee on Water Quality?* Yes No Donation amount LEVEL 1 Donor: $25.00 LEVEL 2 Donor: $50.00 LEVEL 3 Donor: $100.00 LEVEL 4 Platinum Donor: $250.00 Your Donation Amount Your amount Total CostTotal Credit Card*Card Details Cardholder Name Email Confirmation / Receipt*
