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Course Name*

Course Location*

Course Date*

Course Time*

All classes are Full Day unless otherwise noted on agenda.

Name (As it appears on your DNR Certification)*

First Last

DNR Operator Certification Number (put 0 in here if not certified)*

Employer*

Address*

Street Address City ZIP Code

Email*

Phone*

Payment Type*

Check in the mail (Please do not send with attendee to class)

Paid by Credit Card On-line

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If you select Pay Online, your form will be submitted and you will be redirected to our online payment portal. If you choose to send a check by mail, please send it to 350 Water Way, Plover, WI 54467