Pay for a course with a check or money order

PLEASE PRINT ONE FORM FOR EACH COURSE PURCHASED.
(One check may be submitted for multiple purchases.)
Full name:
Phone number:
E-mail:
Certification type:
Payment is for:
Amount to enclose:
Special notes:

  Only after filling in all information,
  

Please print and include this page with your payment. If you do not have a printer, simply write down the information requested on this form and include it with your payment.

Make your check or money order payable to the Alliance of Indiana Rural Water and send to:

Alliance of Indiana Rural Water
P.O. Box 789
Franklin, IN 46131

Note: You will not be able to access the online course for 10 working days after AIRWA receives and processes your payment. You will receive an email when you are able to access the course.