Municipal Water Summit 2019 Application

Please complete the below form to apply for the Summit. Make sure to complete the entire form and then click the blue "Continue" button. Please feel free to call Katie Sieracki at 847-773-0147 with any questions. We look forward to reviewing your application!

Event: Municipal Water Summit 2019
First Name*
Last Name*
Your Title*
Company*
First Name on Badge if different from above
E-Mail*
Confirm E-Mail*
Work Address*
City*
State (two-letter abbreviation)*
ZIP/Postal*
Work Phone Number*
Cell Number*
Website
Emergency Contact Person AND Phone Number*
 
To verify that you're a real human and not an automated spambot, please answer the following question:
Independence Day is the Fourth of*
 
*These fields are required to have a value.

Please tell us about your organization:

Tell us a little about your organization:

What's the population size for which your treatment plant services?

How many treatment plants do you manage?

Does your system handle collection and/or treatment of wastewater?

Please describe your sewer infratructure (number of pumping stations, number of stormwater basins, miles of sewers)

How many gallons (MGD) of water does your treatment plant(s) process daily?

What is currently going well at your organization?

What keeps you up at night regarding your organization?

If you could have dinner with a two or three others in the industry who would you choose?:

If you could join two roundtable discussions with several of your peers, what would the discussion topics be titled? (type N/A if not applicable)


PROCUREMENT:

Do you make the purchasing decisions or make recommendations for purchasing in your organization?

What is your organization's projected budget for new products, services or facilities in the next 12-18 months?

Please list 3-5 suppliers or service providers you'd like to learn more about:

What is the name and title of your immediate supervisor?:

I Agree: If I am selected to attend the Summit, I agree to be present for all sessions, meetings and functions while at the event

Please enter a Bio - a few short sentences (250 words or less). If selected to attend, this information will be used in the Summit Guidebook
Please only click the "continue" button once. The application will take a moment to process your responses.