Registration Form for CEU Hours
Name:__________________________________
Address_________________________________
City____________________________________
State____________________________________
Zip_____________________________________
Phone # ( ) ___________________________
E-Mail (optional)__________________________
Enter Your Arizona License Numbers Below.
Private Applicator #________________________
Commercial Applicator #____________________
Pest Control Advisor #______________________
Signature___________________________________________Date__________________
For more information or assistance call:
Tim Braun: Home (928) 726-8958 Robert Braun (928) 580-7801
Email tbraun783@aol.com
( ) Small Grain Weed Control
( ) Cotton Weed Control
( ) Corn Weed Control
( ) Melon Weed Control
( ) Lettuce Weed Control
( ) Cole Crop Weed Control