2009 Applicator License Training Workshop
Registration Form
Click here to download a two page pdf of the Training Workshops information and registration form. 
Please use one form per person
| Your Name/Company: | |||||
| Address: | |||||
| City: | State: | Zipcode: | |||
| Daytime Phone: | |||||
| Fax Number: | |||||
Please select the location and date of the workshop you wish to attend. Please consider selecting a workshop that is held at least 1 week before your exam.:
The registration fee is $130.00/person. (This fee only covers the cost of the workshop with refreshments. Pesticide exam study materials and exam fees are not included. Please order your pesticide exam study materials separately as soon as possible)
Make the check or money order payable to University of Massachusetts. Governmental Purchase orders may be submitted via fax (413)545-5858. Tax ID Number is 043-167-352.
Print (2) copies of this form, keep one copy for your records and mail the other copy with your check or money order to:
Pesticide Education
Agricultural Engineering Building, Room 212
250 Natural Resources Road
University of Massachusetts
Amherst, MA 01003-9295
If you have any questions regarding these workshops, call the Pesticide Education office, University of Massachusetts Extension at (413) 545-1044
