La Rural Water AssociationCertification Training

April 23-26, 201832 Hour Water levels 1 & 2

32 Hour Wastewater levels 1 & 2

Wayne fontenot training center/lrWA office1325 3rd Ave, Kinder, LA 70648

These training courses are being provided for those interested in becoming certified or advancing certification levels inWater (Production, Treatment and Distribution) or Wastewater (Treatment and Collection). Courses have been approvedby Louisiana Department of Health.

cancellation/refund policyLRWA will charge a $75.00 processing fee for

All cAncellAtionS. Rather than cancel, consider sending a substitute.

no refunDS iSSueD for cAncellAtionS reQueSteD

1 WeeK prior to clASS.

The Water & Wastewater Need-to-Know:http://new.dhh.louisiana.gov/index.cfm/page/982

Manuals may be brought to class as additional study aids.

Students are responsible for their own meals.

Classroom size is limiteD; please mail registration formeArly to reserve seating. Don’t forget to make hotel reser-

vations, if needed and apply to take exam.

registration will close when the seating limit has

been met.

Operator Exam Date

April 27, 2018Kinder community center

316 North 8th St, Kinder, LA 70648

Pre-approval Required

Preapplication submitted to LDH required

30 days or more prior to exam date

32 hour Course Required

http://new.dhh.louisiana.gov/assets/oph/cen-

ter-eH/operator/Application-for-operatorex-

ams.pdf

Question regarding exams

contact lDH certification office

225-342-7508

Instructions for Attending Course and Taking ExamCarefully follow ALL instructions to register for both the course and the exam.

1. Complete and submit ApplicAtion for operAtor certificAtion exams 30 days or more prior to exam date to be el-igible to take exam. Submit to lDH/opH/operator certification p.o. box 4489 bin #10 box #6 - baton rouge,

louisiana 70821-4489. Application for Operator Certification Exams can be found:

a. at http://new.dhh.louisiana.gov/assets/oph/center-eH/operator/Application-for-operatorexams.pdf

b. by calling LRWA Office to have the form faxed to you

c. LRWA’s website (lrwa.org) under Resources; LDH Operator Certification Information

d. Do not send exam Application to lrWA, send to LDH address above.

2. Complete and submit the next page along with payment to register for training course. Submit to lrWA, Attn: cer-

tification training, po box 180, Kinder, lA 70648, or go to lrwa.org and click on “training Sessions” button or“events” tab to register online and pay by credit card.

monday-thursday from 8am to 5pm Member non member

mark 1 class April 23-26, 2018 (Kinder) -- 32 Hours

$300 $340Water levels 1 & 2 (production/treatment/Distribution)

Instructor: Vern Breland -- Course #57638

Wastewater levels 1 & 2 (treatment/collection)

Instructor: Dixie Griffin -- Course #57574

40 hours of instruction needed (ONLY for individuals that have received notification from LDH statingthey need 40 hours of instruction to be eligible for the exam. Call LDH @ 225-342-7508 with questionsor if you have taken the exam 3 times and failed; this is an indication you may need 40 hours.

$100

Exam Hours Only

Exam Hours Only

please select only one (1) class below and indicate if you are attending class to take

the exam or certification credit hours only.

System Name

First Name Last Name Title

State Operator Id # and last 4 digits of SS # (required) Email Address for confirmation letter

Office Phone # Cell Phone # Fax #

System Mailing Address Home Business

City State Zip

Payment Method

Check: Payable to La Rural Water Association

Mail to: La Rural Water Association, PO Box 180, Kinder, LA 70648

800-256-2591 or 337-738-2896

Credit Cards accepted: Visa/MasterCard/Am Express/Discover (4% processing fee on cc)

If paying by credit card, fax (337-738-5620) or email (larwa@centurytel.net) form

Card Number:___________________________________________________________________

Expiration Date:____________________________ Amount Charged:______________________

Phone #:_______________________________Email:____________________________________

Signature:______________________________________________________________________

LRWA Office Use

Date Rec’d:______________

Amount:________________

Check #:________________

$75.00

processing fee on All

cancellations

no refunds 1 week

prior to class

lrWA April 23-26, 2018 certification classes

lrWA office in Kinder, lA