Region 4 (Dallas–Fort Worth) Operator Exam: Registration Form

Map, Accommodations, and Directions to the Regional Training Center

Please fill out the following form to register for the test. * indicates a required field.

If registering under the Texas Small Public Water System Training Program, list the attendee’s TSPWS number after his or her name.

Agency*

Address*

City*

State*

ZIP Code*

Person to Attend First Name*

Person to Attend Last Name*

Exam Date* -- Please Select an Exam Date -- January   7, 2009      12:15 PM January   15, 2009      08:15 AM January   15, 2009      12:15 PM February   11, 2009      12:15 PM February   18, 2009      12:15 PM

TSPWS Number

Type/Level of Test*   

Retest?

YES NO

Additional Attendee First Name*

Additional Attendee Last Name*

TSPWS Number

Type/Level of Test*   

Retest?

YES NO

Additional Attendee First Name*

Additional Attendee Last Name*

TSPWS Number

Type/Level of Test*   

Retest?

YES NO

Additional Attendee First Name*

Additional Attendee Last Name*

TSPWS Number

Type/Level of Test*   

Retest?

YES NO

Additional Attendee First Name*

Additional Attendee Last Name*

TSPWS Number

Type/Level of Test*   

Retest?

YES NO

Person Sending Registration*

E-Mail Address*

Work Phone Number*

Fax Number

   

Contact
TCEQ DFW Regional Office
Sally Currier
2309 Gravel Drive
Fort Worth, TX 76118
817-588-5800, 817-588-5700 fax