Pesticide Education Program

2008 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.:

Eastern Region Extension Center, UMass, Waltham		Western Massachusetts	UMass Cranberry Experiment Station, East Wareham
January 24 & 25 February 6 & 7 February 12 & 13 February 26 & 27 March 4 & 5 March 20 & 21 March 25 & 26 April 1 & 2 April 8 & 10	April 15 & 16 April 30 & May 2 May 21 & 22 August 7 & 8 September 11 & 12 October 9 & 10 November 6 & 7 December 4 & 5	January 22 & 23 (Amherst, MA) March 12 & 13 (Northampton, MA)	Jan. 31 & Feb. 1 March 6 & 7 May 8 & 9

For our information, what date will you take the exam?

What type of work will you be doing? Landscaping Exterminating Agricultural Rights-of-way Lawncare/Golf Course Schools Towns - DPW Housing Authority Other:

Reset this Form:

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