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1. First Name

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2. Last Name

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3. Job Title

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4. Facility Name

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5. Street Address

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6. City

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7. State

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8. Zip Code

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9. Phone Number

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10. Email Address

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11. What State are you representing?

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12. Do you have any dietary restrictions or special needs? Please specify

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13. Will you be attending the Network Evening Reception?

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14. Please check the day(s) you plan to attend the conference (check all that apply):

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15. There will be a session entitled "Ask the Regulator". If you have any questions for the EPA or State Regulators, please provide them here.

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16. Please indicate the Pretreatment Issues Roundtable Topics that would interest you. (check all that apply)

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17. Registration Fees for the Conference

You’ll enter payment info after the survey.
To pay for the conference using PayPal, please click the link below.
If paying by check, mail the applicable registration fee (Municipal or Company checks - personal checks will not be accepted) payable to NERPCA to the address below by October 15, 2026:

New England Regional Pretreatment Coordinators Association
PO Box 960937
Boston, MA 02196

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