IPM for FOOD PLANTS Seminar
Registration Form

 
 

 

Registration  Fee   (two days)                           $700.00  per person.

    

Early Bird  Registration  - by Mar. 1, 2016    $600.00  per person.

 

Pay for 3 from one company                             $2,100.00 

     Register a fourth person at no cost
    Be sure to include information about additional participants below.

 

Multiple Registration Discount

When three people enroll from the same company location, a fourth person may attend at no cost. All participants must enroll at the same time to take advantage of this discount.  Print registration for each attendee.

 

Pay online or print this page and mail it with a check payable to RK Pest Management Services or, if paying by credit card please fill out the following information:
 

     

Purchase order number

(RK Customers ONLY)

 

     

NAME ON CARD

CARD NUYMBER

EXP.DATE  (mm/yy)     SECURITY CODE Back of Master Card and VISA (3digits)
                                                                                                        Front of AMEX (4digits)

SEMINAR INFORMATION

NAME 

TITLE

COMPANY

ADDRESS

CITY STATE   ZIP CODE

BUSINESS PHONE   FAX

E-MAIL

CERTIFIED IN STATE(S) 1) 2) 3) 4) 5)

CHECK, IF NOT CERTIFIED

ADDITIONAL PARTICIPANT 1

NAME 

TITLE

COMPANY

ADDRESS

CITY STATE   ZIP CODE

BUSINESS PHONE   FAX

E-MAIL

CERTIFIED IN STATE(S) 1) 2) 3) 4) 5)

CHECK, IF NOT CERTIFIED

ADDITIONAL PARTICIPANT 2

NAME 

TITLE

COMPANY

ADDRESS

CITY STATE   ZIP CODE

BUSINESS PHONE   FAX

E-MAIL

CERTIFIED IN STATE(S) 1) 2) 3) 4) 5)

CHECK, IF NOT CERTIFIED

ADDITIONAL PARTICIPANT 3

NAME 

TITLE

COMPANY

ADDRESS

CITY STATE   ZIP CODE

BUSINESS PHONE   FAX

E-MAIL

CERTIFIED IN STATE(S) 1) 2) 3) 4) 5)

CHECK, IF NOT CERTIFIED

ADDITIONAL PARTICIPANT 3

NAME 

TITLE

COMPANY

ADDRESS

CITY STATE   ZIP CODE

BUSINESS PHONE   FAX

E-MAIL

CERTIFIED IN STATE(S) 1) 2) 3) 4) 5)

CHECK, IF NOT CERTIFIED

 

For Further Information
 

RK Pest Management Services

8 Rego Court

Huntington Station, NY 11746

 

ATTN:  Anne

anniek@rkchemical.com

 

(631) 421-1120

(866) 800-7378 Toll Free

(631) 421-1504 FAX      

 

 

Press the SUBMIT button ONLY ONCE and wait for the CONFIRMATION PAGE. Thank you.