Virginia Nursery & Landscape Association, Inc.

                  383 Coal Hollow Road, Christiansburg, VA 24073-6721

                                   540-382-0943  -  1-800-476-0066  -  Fax: 540-382-2716
                                                                                                info@vnla.org

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Your Name _______________________________________________________________

                                (Last)                               (First)                               (Middle)

Home Address _____________________________________________________________

City ____________________________________________________ State______zip+4______________-___________

Home Phone (______)________-______________Work Phone (______)________-______________

Email address: _____________________________________________________@_____________________________

Original Certificate#________ (if available)                   Original Certification Date:____/_____/______

Current VNLA Employer: _____________________________________________________________

Business Address: ___________________________________________________________________

City ______________________________________ State______zip+4______________-___________

Your Name as to appear on Certification Badge (max. 22 letters)_________________________________________

Company Name as to appear on Certification Badge (max. 22 letters) ______________________________________

                Enclose a check for $30.00, payable to: VNLA Re-Certification

             (Please allow 4-6 weeks to have your badge and Certificate printed)

AS A 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 Certified Nurseryman in newspapers, yellow pages or any other media, or in any manner
whatsoever imply that I am so certified.

6. I understand and agree that Virginia Certified Nurseryman 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 in good standing 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)

                                                                                              Received ___/____/________        Check #:__________