How Can I Register for the 2012 Pesticide Notification Registry?

To be included on the Pesticide Notification Registry, applicants must submit the following forms (these forms are available below):

• Pesticide Notification Registry Application
• Physician's Certification
• Additional Properties Listing

Please submit the above forms to the Michigan Department of Agriculture and Rural Development on an annual basis.  In order to be placed on the 2012 Notification Registry, applications and supporting documents must be received no later than February 1, 2012.  

Forms:

• Pesticide Notification Registry Letter (Instructions)
  
  This letter includes instructions for using the forms found below.  If you have questions, contact Marie White at (517) 241-1169.
  
  
• Pesticide Notification Registry Application

The application form contains the applicant's information and must include the applicant's nine digit zip code, adjacent property address information and physician's information.  

Adjacent property addresses are defined as properties which share a common boundary line or corner with the property to be treated or which are directly across a residential road, stream or other right-of-way from the property to be treated.  In agricultural areas, adjacent properties means properties or planted crops which share a common boundary line or corner with the area to be treated or which are directly across a secondary road, stream, or right-of-way from the area to be treated.   

• Physician's Certification

The physician certification form regarding the patient's current medical diagnosed condition or ailment specifies the reason for the patient to be placed on the notification registry.  This document must accompany the notification registry application.

• Additional Properties Listing

Regulation 637 Rule 5 1(b) allows for recommended additional distance notification provided it is deemed necessary and substantiated by a physician.  The physician's information must include the recommended additional distance notification in feet. 

Contact Information: