Termite and Other Wood-Destroying Organisms Registration Form



This training is required by OSHA for all employees of all industries that manufacture, import or distribute (including use/storage/sale) of chemicals and must be completed by December 1, 2013. This course is NOT approved for Florida Pest Control License renewal but can be considered technician training.

The information you provide is used to complete your Record of Attendance and for Billing purposes only. 

Last Name  
First Name  
Credential Number  
Where would you like us to mail your
Attendance Form to:
Mailing Address  
Zip Code  
Home Telephone (999-999-9999)  
Business Telephone (999-999-9999)  
Date of Birth (MM/DD/YY)  
Personal ID Number (Last 4 Digits of Social Security #)  
Payment Method Credit Card (MasterCard, Visa or American Express)
Money Order
The following fields are required if you are paying by Credit Card- Thank you!
Name on Credit Card
Credit Card Number - - -
Expiration Date (MM/YY)
Billing Address of Credit Card
Billing Zip Code
Please enter the security code in the box  
Please press just ONCE
  Submission of this registration will take you directly to the course material.  You will be required to remain in the materials area for no less than one hour and fifty minutes
  Pressing this button will reset the form and remove all of your information