UNL Irrigation Home Study Registration Form -- Please print and attach check
*First Name: *Last Name:
*Mailing address:
*City: *State: *ZIP:
Phone: Fax :
Email:
*Number of courses needed: ($60 per course) *Total Amount Enclosed: $ (Check payable to UNL Extension) Yes, I would like to take the quizzes on the Internet and receive instant feedback to my answers. Please send me a user ID and password for the Internet version. (If you check this option make sure and include your e-mail address above). *Required fields for registration form
Return this form and a check to: Dee Petersen Ag. Chemical Institute Fax: 402-762-3600 Phone: 402-762-3644 Email: Top of Page Irrigation Home Study Homepage
Irrigation Management Home Study Course Irrigation Management Home Study Course