CaribDA Workshop Registration – Cayman Islands – October 30-31, 2018 "SWRO Operator Efficiencies & Troubleshooting" WorkshopGrand Cayman, Cayman IslandsTuesday-Wednesday, October 30-31, 2018 RegistrantSalutation*Mr.Mrs.Ms.Dr.First Name*Middle InitialLast Name*Job Title*Company*Address*City*State*Zip/Postal Code*Country*Phone*CellFaxEmail* Website Special Needs Food Allergies (describe in comments) Gluten Free Meals Halal Meals Vegan Meals Vegetarian Meals Wheelchair Access Other (describe in Comments) Member CaribDA IDA Communication and Data Sharing PreferenceCaribDA has been diligent in Data Security and being compliant with US and other Nations regulations.Email Notifications*Yes, I authorize receiving publication email notificationsNo, I would not like to receive publication email notifications (opt-out)Authorization for receiving publication email notification from CaribDA.(applies to all email addresses on this form)Data Sharing*Opt-In: It is ok to share my contact information (name, job title, company, address, email, phone, etc.) with CaribDA Board, Event Sponsors, Speakers, Moderators & Attendees.Opt-Out: Do not share my contact information. Outside of CaribDA Administration, only my name, title and company will be shared with CaribDA Board, Event Sponsors, Speakers, Moderators & Attendees. Workshop & Sponsor RegistrationRegistration and Payment must be received by Oct. 15, 2018 to receive the early registration rate.Today - Date Early Rate Workshop Registration*Members/Affiliates (must be from the list above), $250.00 USDNon-Members (includes 2 Year Individual Membership), $330.00 USDNot attending, Sponsor Only(For other types of Membership-please contact CaribDA for membership application or see our online Membership Application form.)Workshop Registration*Members/Affiliates (must be from the list above), $300.00 USDNon-Members (includes 2 Year Individual Membership), $380.00 USDNot attending, Sponsor Only(For other types of Membership-please contact CaribDA for membership application or see our online Membership Application form.)ExhibitTable Top, $750.00 USDNone (Spaces are selected onsite - first come, first served.)SponsorMajor, $1,000 USDLunch, $750 USDBreakfast, $500 USDBreak, $350 USDNone (Spaces are selected onsite - first come, first served.) Workshop Attendee*Yes, same as aboveNo, different than aboveIncluded in the exhibitor package and major sponsorship package.Salutation - Attendee*Mr.Mrs.Ms.Dr.First Name - Attendee*Middle Initial - AttendeeLast Name - Attendee*Job Title - Attendee*Company - Attendee*Address - Attendee*City - Attendee*State - Attendee*Zip/Postal Code - Attendee*Country - Attendee*Phone - Attendee*Cell - AttendeeFax - AttendeeEmail - Attendee* Website - AttendeeData Sharing*Opt-In: It is ok to share my contact information (name, job title, company, address, email, phone, etc.) with CaribDA Board, Event Sponsors, Speakers, Moderators & Attendees.Opt-Out: Do not share my contact information. Outside of CaribDA Administration, only my name, title and company will be shared with CaribDA Board, Event Sponsors, Speakers, Moderators & Attendees. Total Registration Fee $0.00 Payment InformationPayment Method*Credit Card - Online PaymenteCheck (Bank Wire w/o processing fee) - Online PaymentCheckInvoice CommentsIf you would like a copy of the invoice/receipt sent to another*Yes, send copy of invoice/receipt to:No, don't need a copy sentIf yes, you would like a copy of the invoice/receipt sent to another other than the attendee please enter information below.Name* First Last Email Address* Comments/Questions Cancellations/RefundsWritten cancellation requests received on or before Oct. 15, 2018 will receive a refund, less a $50 processing fee. Full payment is required if cancellation is received on or after Oct. 16, 2018 - no refunds and no credits for future events will be granted. However, substitutions may be made at any time. CaribDA reserves the right to make changes in programs and speakers, or to cancel programs when conditions beyond its control prevail. Every effort will be made to contact each enrollee if a program is cancelled. If a program is not held, CaribDA’s liability is limited to the refund of the program fee only. Final Step of Application ProcessPlease enter the letters displayed below to complete your application and then click Submit.CAPTCHA