Registration Form

PestNetwork.com, Inc.

P.O. Box 81552
Austin, TX 78708-1552 FAX: (512) 990-0665
Phone: (512) 990-3216

CREDIT CARD INFORMATION MUST MATCH CREDIT CARD NUMBER

VIRGINIA Registration

Credit Card Registration:

*Cardholder Name (First, Middle Initial):

*Cardholder Name (Last):

*Mailing Address:

*City:

*State / Zip:
/

Applicators Information if different from Cardholder:

First Name:

Last Name:

Mailing Address:

City:

State / Zip:
/

*App. License # State Abbrev.:

* Phone:

Fax:

*Email:

*Confirm Email:

* Represents required fields.

You must complete all credit hours registered for within the ceu time frame period that you registered in.

No credit hours will carry forward.

COURSES
Core Category Courses List
	Environmental Protection	1 CEU
	Managing Pesticide Drift	1 CEU
	Pesticide Applicator Safety	1 CEU
	Pesticide Families	1 CEU
	Identifying Cockroaches In and Around the Home	1 CEU
	Life History and Habits of Carpenter Ants	1 CEU


Core Category 1-A (Agricultural plant pest control)
You must click the box next to the course in Core Category Courses List above, and you must take all courses in this group for credit. This way avoids duplcation.
Environmental Protection		1 CEU
Managing Pesticide Drift		1 CEU
Pesticide Applicator Safety		1 CEU
Pesticide Families		1 CEU
AND
Choice of one of the following:
	Grasshoppers on Pastures and Rangeland	1 CEU
	Insect Pests That Attack Cotton - The Boll Weevil	1 CEU
	Insect Pests That Attack Cotton - The Cotton Fleahopper	1 CEU
	Know Your Cotton Plant	1 CEU
	The Greenbug	1 CEU
AND
Choice of one of the following:
	Facets of IPM Field Crops	1 CEU
	Principles of IPM in Field Crops	1 CEU
AND
Choice of one of the following:
	The Environmental Protection Agency (EPA) and Its Role In Pesticide Application	1 CEU
	The Federal Insecticide, Fungicide and Rodenticide Act (FIFRA)	1 CEU

Core Category 7-A (General pest control)
You must click the box next to the course in Core Category Courses List above, and you must take all courses in this group for credit. This way avoids duplcation.
	Environmental Protection	1 CEU
	Identifying Cockroaches In and Around the Home	1 CEU
	Life History and Habits of Carpenter Ants	1 CEU
	Pesticide Applicator Safety	1 CEU
	Pesticide Families	1 CEU
AND
Choice of one of the following:
	The Environmental Protection Agency (EPA) and Its Role In Pesticide Application	1 CEU
	The Federal Insecticide, Fungicide and Rodenticide Act (FIFRA)	1 CEU

Core Category 7-B (Wood Destroying pest control)
You must click the box next to the course in Core Category Courses List above, and you must take all courses in this group for credit. This way avoids duplcation.
	Environmental Protection	1 CEU
	Pesticide Applicator Safety	1 CEU
	Pesticide Families	1 CEU
AND
Choice of two(2) of the following:
	Beetles That Attack Wood: Identifying Beetles That Will Reinfest	1 CEU
	Beetles That Attack Wood: Identifying Beetles That Will Not Reinfest	1 CEU
	The Eastern Subterranean Termite	1 CEU
	Life History and Habits of Carpenter Ants	1 CEU
AND
Choice of one of the following:
	The Environmental Protection Agency (EPA) and Its Role In Pesticide Application	1 CEU
	The Federal Insecticide, Fungicide and Rodenticide Act (FIFRA)	1 CEU

Total Number CEUs Ordered: TOTAL AMOUNT DUE: .

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PestNetwork.com, Inc.

COURSES

Core Category Courses List

Core Category 1-A (Agricultural plant pest control)

AND

AND

AND

Core Category 7-A (General pest control)

AND

Core Category 7-B (Wood Destroying pest control)

AND

AND