30 Hr Registration Form
Please read both the side and bottom of this registration form before registering for any class!
_____________________________________________________________________
REGISTER (please print)
_______________________________________________________________________
Class Location: _____________________________
Class Date(s):____________________________
Please check which 30 hour Category you are signing up for
[
] 30 Hour [ ] 3A [ ] 5A [ ] 6A [ ] 7A [ ] 7D [ ] 7F [ ] 7G
Session Number(s): ____________________________
Name:________________________________________________________
First MI Last
Certification #__________________________________________
Home Address:_________________________________________________
City:______________________ State:_________ Zipcode:__________
Home Phone #____________________ Work Phone #:___________________
Fax #: _________________
Payment: [
] Check: Make check payable to: Pesticide Training
& Consulting
[ ] Cash
[ ] PayPal 91.00 1/2 day, 182.00 day, 607.00 30 hour class
[ ] Purchase Order: (must have PO number and address for billing)
Paperwork must accompany registration
Credit
Cards MUST USE PAYPAL button on the left but you still
need to mail, fax or call the information in on this form so that you will be signed up for the
class. The button only pays for the class, but does not tell what class you are signing up for.
These Prices are for Cash, Money Order or Checks only
NO LUNCHES PROVIDED
30 Hour Class fee - $585.00 per person
Pre-registration fee - $175.00 per person per day
On-site registration fee - $180.00 per person
Half day registration fee $85.00 per person
**Cancellation -
Cancellations can be made 5 days prior to class date with a
refund of
tuition minus a $30.00 cancellation fee. Substitutions are permitted
(please notify us in advance). If there is no cancellation and/or no one
attends
the class, the registrant is still responsible for payment of
the class, and will be
billed and not be able to take future classes until the bill is paid.
By registering for this class, the registrant agrees to the above terms,
as well as wearing a mask for the whole class and waiving any right to
sue me if you contract Covid-19.
A fee of $30.00 will be charged for returned checks.
CANNOT ELECTRONICALLY REGISTER - MUST PRINT AND MAIL, EMAIL OR
FAX FORM TO:
Pesticide Training & Consulting
P.0. Box 462
Bridgeport, NY 13030
phone/fax
315-288-4954
