2011-2012 Commercial Pesticide Training and Certification Clinics

Please make your registration selections below. If you would like to register multiple individuals with one payment, please complete the form below for each person. After each form, you will be prompted to add another individual or complete the registration process.

Contact Information of Attendee

Please enter the contact information for the person attending the training.

First Name*
Last Name*
Company
Address Type Work/Business Home
Address*
Address 2
City*
State*
Zip Code*
County (IL only)
Phone 1* - Phone 1 (part 2) - Phone 1 (part 3) Ext. Phone 1 Extension
Phone Type Business Home Cell
Phone 2 - Phone 2 (part 2) - Phone 2 (part 3) Ext. Phone 2 Extension
Phone (Secondary) Type Business Home Cell
E-mail Address

Company/Organization Contact

If applicable, please enter the contact information for a company/organization contact for any billing inquiries we may have.

Contact Name
Contact Phone Contact Phone - Contact Phone (part 2) - Contact Phone (part 3) Ext. Contact Phone Extension
Contact Email

Related Publications

Please enter the number of each publication you would like to order.

General Standards Manual @ $10.00 each
General Standards Workbook @ $2.00 each
General Pesticide Safety Manual (Spanish) @ $10.00 each
Bilingual General Standards Workbook (Spanish) @ $2.00 each
Aerial Applicator Manual @ $15.00 each
Aquatic Weed Control Manual @ $15.00 each
Aquatic Weed Control Workbook @ $2.00 each
Dealer Manual @ $15.00 each
Demonstration & Research Manual @ $15.00 each
Field Crops Manual @ $15.00 each
Field Crops Workbook @ $2.00 each
Forest Manual @ $15.00 each
Fruit & Vegetable Manual @ $15.00 each
Grain Facility Manual @ $15.00 each
Grain Facility & Seed Treatment Workbook @ $2.00 each
Livestock Manual @ $15.00 each
Mosquito Control Manual @ $15.00 each
Mosquito Control Workbook @ $2.00 each
Ornamentals Manual @ $15.00 each
Plant Management Manual @ $15.00 each
Plant Management Workbook @ $2.00 each
Private Applicator Workbook @ $2.00 each
Private Applicator Manual @ $10.00 each
Rights-of-Way Manual @ $15.00 each
Rights-of-Way Workbook @ $2.00 each
Seed Treatment Manual @ $15.00 each
Sewer Line Root Control Manual @ $15.00 each
Soil Fumigation Manual @ $15.00 each
Turfgrass Manual @ $15.00 each
Turf & Ornamentals Workbook @ $2.00 each
Stored Grain Pest Management CD @ $30.00 each
ICLTP - Commercial Landscape & Turf Handbook @ $16.50 each
Home Yard & Garden @ $25.00 each
Calculator @ $5.00 each

Ship these publications to a different address than listed above

Shipping Address for Publications

Please complete the following section.

First Name*
Last Name*
Company
Address*
Address 2
City*
State
Zip Code*

Cost of Training, Testing and Publications

Item	Cost
Registration Fee (training and/or testing)	$0.00
Publications Cost (includes $1.50 per item shipping)	$0.00
Total Cost	$0.00

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