HOME NAME                                                                                                   ADDRESS                                                                                             CITY                                               STATE                      ZIP                TELEPHONE                                  E-MAIL                                           BUSINESS COMPANY NAME                                                                                  ADDRESS                                                                                             CITY                                               STATE                      ZIP                TELEPHONE                                  E-MAIL

Please register me for the following: Members Non-members         (1) Installation Exam $375 $395         (2) Maintenance Exam $375 $395         (3) Irrigation Exam $375 $395         Retake $50 $50 Circle the Module(s) to be retaken:    1    2    3         Installation Manual $75 $90         Maintenance Manual $75 $90         Irrigation Manual $75 $90 TOTAL = $

Please print this form, fill it out and mail with check to:
NY State Turf & Landscape Association (CLT)
1 Prospect Avenue, White Plains, New York 10607