Commercial Pesticide Applicator Training
Recertification Registration Form

In order for MSU-ES to continue to upgrade the Commercial Pesticide Applicator Program we must charge a fee for the Recertification Program.  By preregistering, you are guaranteeing your seat in the class and reserving your recertification manual.  If you register at the meeting location the day of the meeting, there is no guarantee you will have a seat or a manual and the late registration fee will be $40.00.  

NOTE:  Payment of your $30.00 preregistration fee should be received by our office no later than five (5) working days prior to the recertification meeting date.

Please make your check payable to:  MSU-ES, CMREC. Mail, along with a copy of this registration form, to:

Elmo Collum
Central MS Research & Extension Center
Attn: Veronica Leonard
1320 Seven Springs Road
Raymond, MS  39154

If you need more information, contact Veronica Leonard
(601) 857-2284 phone
(601) 857-2358 fax

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After you fill out this form, please print two copies before you click the 'Submit' button.  Keep one copy for your records and mail the other copy with your payment.  

* Indicates Response Required

*Pesticide Applicator Certification No.
*Expiration Date (mm/dd/yyyy)
*Company Name
*Last Name
*First Name
*Address
*City
*State
*Zip Code
*Email Address
*Phone Number - numbers only (ex: 6015552121)
*Select your location/date: Batesville, January 5, 2012 Batesville, April 5, 2012 Batesville, July 5, 2012 Batesville, October 4, 2012 Biloxi, April 11, 2012 Biloxi, October 10, 2012 Hattiesburg, January 18, 2012 Hattiesburg, July 11, 2012 Raymond, January 3, 2012 Raymond, April 3, 2012 Raymond, July 3, 2012 Raymond, October 2, 2012 Stoneville, February 16, 2012 Stoneville, May 10, 2012 Stoneville, August 16, 2012 Stoneville, November 15, 2012 Verona, February 14, 2012 Verona, May 8, 2012 Verona, August 15, 2012 Verona, November 13, 2012
. .