Virginia Nursery & Landscape Association Certification Board 383 Coal Hollow Rd; Christiansburg, VA 24073-6721 Phone: 540-382-0943 or 1-800-476-0055; Fax-540-382-2716 Email: info@vnla.org

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Application Date: _______/______/200__ 
(Include Test fee: $75.00 members; $300.00 non-members)

Your Name: ________________________________, ________________________ __________________
                             (Last)                                             (First)                                         (Middle)

Home Address___________________________________________ County: ________________________

City: _______________________________________State______ Zip__________________-___________

Home Phone (_______)_______-__________________ Work Phone: (______)_______-_______________

Email: ________________________________________________@_______________________________

Male [__] Female [__]     Birthday ____/____/______  Social Security #_______-___________-_________

Current Certified Horticulturist #________, Current VCH Expiration date: ____/____/______

Current Employer: _______________________________________________________________________

Address _________________________________________________________________________________

City _____________________________________________State _____ Zip________________-_________

Your Name as to appear on Certification Badge __________________________________________________
                                                                                    (max.22 characters/spaces)

Your Company Name as to appear on Badge____________________________________________________
                                                                                (max.22 characters/spaces)

====================================================================================================

AS AN ADVANCED CERTIFIED HORTICULTURIST IN THE COMMONWEALTH OF VIRGINIA,
I HEREBY AGREE TO THE FOLLOWING CONDITIONS, TO WIT:

1. I will abide by all present and any future additions or changes in rules and regulations, adopted by the
 Certification Board, a subsidiary group sponsored by the Virginia Nursery & Landscape Association.

2. I will promote the highest ethical standards in the conduct of my nursery work and myself.

3. I will make continued efforts to learn more about nursery products and improve my skills as a
nursery salesperson.

4. I understand and agree that my certification is limited to a stated time period and must be renewed every
three years on terms and conditions prescribed by the Virginia Nursery & Landscape Association
Certification Board. Failure on my part to comply with stated requirements will automatically revoke
my certification.

5. I agree that should my certification ever be revoked for whatever reason, I will not display any distinguishing
emblems, titles, list myself as a Virginia Certified Horticulturist in newspapers, yellow pages or any other
media, or in any manner to whatsoever imply that I am so certified.

6. 1 understand and agree that my Virginia Certified Horticulturist status is granted by the nursery industry
as a recognition of knowledge and achievement and is in no way mandatory and may be granted or refused
or revoked at the discretion of the Virginia Nursery & Landscape Association Certification Board. I further
understand and agree that my Virginia Certified Horticulturist status may be used by me only,  while
 I am employed by a current member of the Virginia Nursery & Landscape Association.

I ACCEPT my Virginia Certified Horticulturist status with no reservations and may use such designation
as long as I am in compliance with the above statements and conditions.

 ________________________________________________________________ Date_____/_____/200__
                    (Applicant’s signature)

To be Completed by Employer Only

I hereby certify that the information on this application is true and correct and
that I am a VNLA member in good standing.

Date _____/_____/200__

________________________________________________________
                VNLA Member Firm Name

________________________________________________________
                Employer Signature Title

Remarks:

=================================================================

Below for Office Use Only 

Test Score:_________ Certification #___________
Entered NOAH ___/____/___ Ofc. Rec’d ___/____/___Test Date ___/___/___
Location:________________ Test Proctor: ________________________

Results Letter ______/_____/______ Badge Sent ______/_____/______
Certificate Sent ______/_____/______

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