UF/IFAS Florida-Friendly Landscaping Program

GI-BMP Class Registration

Please complete the following form to register for an upcoming Green Industry Best Management Practices (GI-BMP) Class.

NOTE: You must enter a separate registration form for each student that needs to register.

If you have any questions or problems completing this registration form, please contact:

Kurt Rowe
ksrsrq@ufl.edu
941-232-8420

1. First Name:

First Name:

2. Middle Name or Initial:

Middle Name or Initial:

3. Last Name:

Last Name:

4. Suffix:

Suffix:

5. Will you require any special assistance as may be required under the Americans with Disabilities Act (ADA)?

Will you require any special assistance as may be required under the Americans with Disabilities Act (ADA)? Yes	No
What Special Assistance Do You Require?

6. CEUs ONLY: I am taking this class ONLY for Continuing Education Units (CEUs) and will NOT sit for the exam and I will NOT receive a GI-BMP certificate.

CEUs ONLY: I am taking this class ONLY for Continuing Education Units (CEUs) and will NOT sit for the exam and I will NOT receive a GI-BMP certificate. Yes

7. After the class, where should we mail your GI-BMP Certificate of Training?

After the class, where should we mail your GI-BMP Certificate of Training? Work Address

Home Address

8. Please create a four digit PIN #:

NOTE: Please write this number down and REMEMBER it!

Please create a four digit PIN #: NOTE: Please write this number down and REMEMBER it!