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REGISTER (please print)
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Class Location (city):_______________________
Class Date:__________
Name:_________________________
Home Phone:___________
Certification/License Number:________________________
Company Name:______________________
Company Address:__________________________
City:_________________________ State:_____________
Zip code:________________
Company Phone Number:_________________
Fax Number:_________________
E-mail Address:__________________________
Payment: [ ] Check
Make check payable to: Pesticide Training & Consulting
[ ] Cash
[ ] Pay Pal $182.00 for the day $91.00 half day
[ ] Purchase Order [must have PO number and address for billing]
Credit Cards MUST USE PAYPAL button at 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.
Please Note Price Change
Pre-registration fee - $175.00 per person cash, money order, check
On-site registration fee - $180.00 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 you will be billed, and not be able to register to take future classes until the bill is paid. You can not change to another class site without notifying us. An additional $25.00 will be charged to cover cost of coming to the new location.
**Guest - You must register any guest brought with you to a class to be sure there is room, and a $25.00 fee will be charged.
By registering for this class, the registrant agrees to the above terms.
A fee of $20.00 will be charged for returned checks.
CANNOT ELECTRONICALLY REGISTER - MUST PRINT THIS FORM AND MAIL, EMAIL OR FAX TO:
Pesticide Training & Consulting
P.0. Box 462
Bridgeport, NY 13030
phone/fax
315-288-4954
