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SPANISH - Basic Pesticide Training / CORE - Webinar

06/04/2024 05:00 PM - 09:00 PM ET

Attendee Info

First Name: Last Name: Company: Email: Day Phone: Business Address: City: State: Zip: - Which Categories best describes your business?

Include myself as an attendee:

Personal Info

Birth Date: / / Last 4 Digits Social Security # I am a Public Health Officer and will be taking this course for NJ-PHCE Credits

Yes

New Jersey Pesticide License # (Only Commercial Pesticide Applicator License # beginning with 2, 5 or 6, otherwise leave blank) Pennsylvania Pesticide License #

IMPORTANT

The Above Information is Sent to the NJDEP Electronically, Please Make Sure Everything is Correct Before Selecting SUBMIT.

Incorrect information can result in lost credits or a delay in obtaining a license.

Waiver Statement:

Registrations may be cancelled up to 3 days before the class. No refunds, but substitutions are permitted. A fee of $20 will be charged for returned checks & replacement of lost certificates.

Payment due prior to class.

Yes, I agree

required fields

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