Registration Form WQA CWS Test Preparation Course

Registration Form
WQA CWS Test Preparation Course
Wednesday, November 12, 2014 • 8 a.m. – 12 p.m.
This exam prep course is a review of the material from the CWS exam study kit. For best results, close reading of all the kit books and materials
is strongly recommended prior to attending the course. Course attendance without prior study does not ensure exam success. We will be
covering highlights on water treatment, contaminants, their origins, chemistries, and treatment technologies.
Register by mail or fax.
Call the certification department with inquiries: 630-929-2508
SEMINAR LOCATION
Ohio WQA Annual Convention
Cherry Valley Lodge
FEES (Please check one.)
PRE-REGISTRATION (by Nov. 3)
c $100 – WQA/EWQA Member
c $200 – Non-Member
ONSITE REGISTRATION: $25
2299 Cherry Valley Road • Newark, Ohio 43055
Modular Education Program (MEP): Getting Started & Basics Badge 1A
Wednesday, November 12, 2014 • 1– 5 p.m.
Using the NEW Modular Education Program (MEP) online software, attendees will complete a set of learning activities required to earn the
Water Quality Basics Badge, the first course in the new education program. This introductory badge addresses basic principles and concepts
of water quality and water analysis. It’s intended for all learners likely to interact with customers, including office and support personnel and
new hires.
Register by mail or fax.
Call the certification department with inquiries: 630-929-2508
SEMINAR LOCATION
Ohio WQA Annual Convention
Cherry Valley Lodge
FEES (Please check one.)
PRE-REGISTRATION (By Nov. 3)
c $50 – current MEP subscribers
c $75 – or non-subscribers
ONSITE REGISTRATION
$75 – current MEP subscribers
$100 – non-subscribers
2299 Cherry Valley Road • Newark, Ohio 43055
INSTRUCTOR: Dean Jarog, CWS-VI, is WQA’s education and professional certification trainer. Jarog, who joined WQA in 2012, had previously served
as a laboratory analyst. With 16 years of experience working in research and development for Everpure, Inc., Jarog has trained numerous employees of
water treatment product dealers and manufacturers. Jarog’s undergraduate work was in Biology and Chemistry at the University of Illinois in Chicago.
He has a Master’s Degree in Environmental Engineering from Illinois Institute of Technology, and holds a Level VI certification with the WQA. He has
several patents and has done extensive research on carbon and its application to water filtration equipment.
INFORMATION (Please print.)
METHOD OF PAYMENT
MR. MRS. MS.
WQA MEMBER NUMBER
Check:
(payable to WQA)
Fee Amount_________________
Charge:MasterCard VISAAMEX Discover
FIRST NAME
MI
LAST NAME
CHECK NUMBER
COMPANY
CREDIT CARD NUMBER
MAILING ADDRESS
EXP. DATE
SECURITY CODE
CARDHOLDER’S NAME
CITY
STATE/PROVINCE
COUNTRY
PHONEFAX
EMAIL
ZIP/POSTAL CODE
SIGNATURE
MAIL OR FAX FEE AND FORM TO:
Water Quality Association • Attn: Certification Department
4151 Naperville Road • Lisle, IL 60532-3696 USA
Phone: 630-505-0160 • Fax: 630-505-9637
A not-for-profit organization
BE SURE TO MAKE A COPY FOR YOUR FILES.
Cancellation Policy: All cancellations must be in writing (signed faxes accepted). Cancellations received after 5:00 p.m. (CST) of the sixth business day preceding the
seminar (e.g. 5:00 p.m., Wednesday, for a seminar beginning on Thursday of the following week) and before final day prior to the seminar will be subject to a 20% cancellation fee. No refunds will be given for no-shows or for cancellations received on the day immediately prior to the seminar or the day of the seminar. If WQA cancels the
seminar due to low preregistration, fees will be refunded.
Modular Education Program (MEP):
Getting Started & Basics Badge 1A
LOCATION:
Ohio WQA Annual Convention
Cherry Valley Lodge
2299 Cherry Valley Road • Newark, Ohio 43055
Workshop Date & Time:
Wednesday, November 12, 2014 • 1–5 p.m.
OBJECTIVE: The NEW Modular Education Program (MEP) employs the Learning Experience Manager (LEM), online progress
tracker and course delivery system. Workshop attendees will complete learning activities for the Water Quality Basics Badge.
This badge is the first course in the new program, intended for anyone likely to interact with customers, including office and
non-technical support personnel and new hires. Attendees should bring their own water-hardness test kit and an internetenabled laptop or tablet computer to be able to enter the information needed to complete each of the learning activities.
Attendees will leave the workshop having completed more than half of the Water Quality Basics Badge.
The Water Quality Basics certificate includes introductory badges that address the basic principles and concepts of water
quality. In order to earn the certificate, you must earn the Water Quality Basics badge.
SCHEDULE
1:00 p.m. – 1:30 p.m. – Welcome and Overview
• B1-F: Discuss Water Quality Basics badge
• How an online activity works
1:30 p.m. – 2:00 p.m. – Learning Activities
• LA-B1: What is water quality? (homework)
• LA-B2: Residential water quality issues
2:00 p.m. - 2:30 p.m. – Learning Activities
• LA-B3: Local effects of water quality
2:30 p.m. – 3:00 p.m. – Learning Activities
• LA-B4: Local effects of hard water
• LA-B5: Causes of water quality
3:00 p.m. – 3:30 p.m. – Learning Activities
• LA-B6: National drinking water regulations
• LA-B7: Measuring water hardness
3:30 p.m. – 4:00 p.m. – Learning Activities
• LA-B8: Local Water Hardness
4:00 p.m. – 5:00 p.m. – Learning Activities
• LA-B9: Test for water hardness (each attendee will measure hardness using a test kit on a
water sample)
CERTIFICATION EXAM
REGISTRATION FORM
OWQA ANNUAL CONVENTION
NEWARK, OHIO
CHERRY VALLEY LODGE
2299 CHERRY VALLEY ROAD, NEWARK, OHIO 43055
EXAM REGISTRATION FEES
EXAM DATE TIME:
(Select all that apply.)
Thursday, November 13, 2014
9:00 a.m. – 12:00 p.m.
BASIC EXAMS (MEMBER/NONMEMBER)
cWater Specialist (CWS)
$115 / $215
cSales Representative (CSR)
$115 / $215
cInstaller (CI)
$115 / $215
c Certified Contractual Operator (CCO)*$115 / $215
INFORMATION
WQA MEMBER NUMBER
MALE
CONTACT FIRST NAME
* Preregistration for the Certified Contractual Operator (CCO) for Very Small Systems MUST be
received in the WQA office NO LATER than four weeks prior to the exam date in order for the
person to be tested at that scheduled session. You cannot register on site for the CCO exam. The
CCO exam can only be taken by persons who have already completed all other requirements for
the CCO title.
LAST NAME
FEMALE
COMPANY NAME
SPECIALTY EXAMS
MAILING ADDRESS
CITYSTATE/PROVINCE
ZIP/POSTAL CODE
COUNTRY
cDeionization by Ion Exchange
cDisinfection
cFiltration
cOzonation
cReverse Osmosis/Ultrafiltration
GRAND TOTAL (U.S.) $______________
COMPANY FACSIMILE
EMAIL
Call for discount information if five or more from the same company attend the
same testing session. You may attend either session.
METHOD OF PAYMENT
Check:
c (payable to WQA Aquatech USA)Check #
Charge:
c MasterCard
c VISA c AMEX c Discover
NOTE:
Preregistration Deadline
A copy of this form plus payment must be received by six business days prior to the
testing session for all exams EXCEPT the Certified Contractual Operator (CCO) Exam.
Registrations received after the preregistration deadlines are subject to the on-site
registration fee.
On-Site Registration
An on-site registration fee of $25.00 is charged for on-site registrations AND all registrations received after the preregistration deadline. Fee must be paid before exam
scores are released. WQA DOES NOT GUARANTEE that persons registered on-site can
be accommodated for testing.
Refunds
Full refunds are made if the examinee cancels the exam registration by six business
days prior to the exam session. NO REFUNDS are given if cancellation is received
AFTER the cancellation deadline. NO REFUNDS are given for “NO SHOWS” who don’t
appear for preregistered exams.
CHECK NUMBER
MAIL, FAX, OR EMAIL COMPLETED FORM TO:
CARDHOLDER’S NAME
EXP. DATE
SECURITY CODE
Water Quality Association • Attn: Certification Department
4151 Naperville Road • Lisle, IL 60532-3696 USA
Phone: 630-505-0160 • Fax: 630-505-9637
Email: dleblanc@wqa.org
BE SURE TO MAKE A COPY FOR YOUR FILES.
SIGNATURE
$90 / $170
$90 / $170
$90 / $170
$90 / $170
$90 / $170
SUBTOTAL (U.S.) $______________
COMPANY TELEPHONE
CREDIT CARD NUMBER
(MEMBER/NONMEMBER)
(to be taken only by currently certified individuals)