Please print out the following registration form and fax or mail to:
Pesticide Industry Council,
c/o Landscape Ontario
7856 Fifth Line South, R.R. #4,
Milton, Ontario, L9T 2X8
Tel: (905) 875-1805
Toll Free: 1-800-265-5656
Fax: (905) 875-3942
E-mail: pic@ptppic.com
Name: ___________________________________________________________________Company: ___________________________________________________________________
Title: ___________________________________________________________________
Address: ___________________________________________________________________
City: ___________________________________________________________________
Postal Code: _____________________ Phone: ___________________ ext. ______
Fax: ________________________ E-mail: _______________________________
Licenced Exterminators Number: ______________________________________________
No. of Years in Pesticide Management: _____________________________________
Trade Association Membership: ______________________________________________
Date of Course: ______________________________________________________________
Registration Fee
(includes a copy of the Technician Training Manual and the Technician’s Guidebook)
$75.00 + G.S.T. (1-5 Tecnicians per order) + Shipping & Handling
$65.00 + G.S.T. (6+ Tecnicians per order) + Shipping & Handling
Payment Details
Visa MasterCardCard Number: _____________________________________________________________
Name of Cardholder: ______________________________________________________
Expiry Date: ______________________
Signature: _______________________________________________________________
