ACWA 2019 Regulatory Summit Video Order Form Please complete this form to view the video online and receive the non-member price of $210. NOTE: For member pricing, please login as a member first. Contact InformationPlease provide contact information for your order.Name* First Last Agency/Organization*Please provide the name of your agency or organizationEmail* PhonePayment2019 Regulatory Summit Video Price: $210.00 This pricing is for non-members. NOTE: For member pricing, please login as a member first.Total $0.00 Billing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Credit Card* MasterCardVisa Card Number Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Expiration Date Security Code Cardholder Name ConsentBy submitting this form I agree to use this video for individual purposes only and will not distribute it.
