May 31, 2024

Dickinson- Stark County Weed Control - 2680 Empire Rd. Door C

Registration: 7:30 a.m.

Training: 8 a.m. - 5 p.m.

Fields with asterisk are required.

Core Status *: Ground Core
Select Categories - No refunds issued for incorrect category selection *: Right of Way [+$25.00]
Ag Pest Control [+$25.00]
Name of Applicator *
ND Certification # (if renewing)
Date of Birth *
Home Street Address *
PO Box (if applicable)
City *
State *
Zip Code *
ND County of Residence *
Email Confirmation Letter to: *
Secondary Email Address (if applicable)
Cell Phone Number *
Mail Certification Card to: *
Certification Status---choose all that apply *: Applicator
Dealer
Consultant
Do you have an employer? *
Employer Name *
Employer Street Address/PO Box *
Employer City *
Employer State *
Employer Zip Code *
Employer Phone # *
Do you work for a government agency? *

$75.00

Qty: