SWCC Designated Technical Specialist Registration (Pursuant to 02 NCAC 59G .0104)

First Name *

Last Name *

Suffix

Organization/Business Name *

Agency/Work Unit *

County/District *

Area *

Home Phone Number *

Work Phone Number *

Mailing Address *

City *

State *

Zip Code *

Email Address *

Place a mark by the category(s) for which designation(s) you currently hold. If you are unsure of your designation(s), you can cross reference the current listing HERE

Designation Category *

Irrigation Equipment (I)

Waste Utilization Planning/Nutrient Management (WUP/NM)

Inorganic Nutrient Management (INM)

Wettable Acres (WA)

Runoff Controls (RC)

Water Management (WM)

Structural Animal Waste (SD-Design) (SI-Inspection)

Additional Information and/or Comments.

I certify that the information provided above is true, complete and correct to the best of my knowledge and belief. In the event confirmation is needed in connection with my qualifications, I authorize employers, clients, educational institutions, associations, registration and licensing boards to furnish whatever detail is available concerning my qualifications. *

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