Arkansas Pest Management

Event Registrations

Please complete the following form correctly. Cancellations/refunds must be requested in writing by September 1st Refunds will be subject to a $50.00 administration fee. All fees online include a Credit Card Convenience Fee built into the individual price.

To purchase shirts separately use THIS LINK.

First Name(*)

Please type your full name.

Last Name(*)

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E-mail(*)

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Member Operator Fee

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Member Technician Fee

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Non Member Operator Fee

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Non Member Technician Fee

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Please list the names & license number of all attending the Recertification

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How many for dinner?

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Short Sleeve Shirts

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Long Sleeve Shirt

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Please Indicate Shirt Size for each

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Total $

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Company(*)

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Company Phone(*)

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Company Address(*)

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City(*)

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State

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ZIP(*)

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Donate to the Scholarship Fund

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Dinner Guest

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Enter Payment Information Below (Visa/Mastercard Only) -------------------------------------------------------------------------

Credit Card Number(*)

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Expiration Month(*)

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Expiration Year(*)

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Card Security Code(*)

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