MASSACHUSETTS FORESTER LICENSE

RENEWAL APPLICATION

 

I, ________________________________, hereby apply to the Director of State Parks and Recreation for a renewal of my Massachusetts Forester License.  I certify that I presently hold Massachusetts Forester License Number ________.  Last License Issue Date:­_______________

 

SIGNATURE:  ___________________________________     DATE:   ______________

 

NOTE:  DCR creates a directory of active Massachusetts Licensed Foresters available on the Commonwealth’s web site.

 

Please make corrections, if necessary, to the information displayed in the address boxes below.

Also, please answer the following questions so that we list your information correctly.

All items with no response will be assumed to be listed correctly.

 

I would like to be listed in a directory of Foresters for public distribution:  Yes___   No____

 

I would like my directory listing and / or mailings to use:  Home Address  _____   

                                                                                       Affiliation Address _____

 

I am currently an SAF Certified Forester (CF):  Yes ____   No ____

 

I am an employee of:  State Government ____   Federal Government ____  Private Sector _____

Other-please specify __________________________________________

 

Home Address

 

       NAME:

ADDRESS:

         CITY:                                                   ST:                                        ZIP:

     PHONE:                                                FAX:

     E-MAIL:

 

 

Affiliation Address

 

AFFILIATION:

       ADDRESS:

                CITY:                                                         ST:                                         ZIP:

            PHONE:                                                      EXT:                                       FAX:

           E-MAIL:

 

 

 

Mail this renewal application to Department of Conservation and Recreation, MA Forester Licensing Board, 433 West Street, Suite 8, Amherst, MA 01002

 

OFFICIAL USE ONLY

Date of Re-issue ­­­­­_______________    Check No. ______________        Check Amount   _____________

                                                                                                                      Exempt (Y/N)

 

Revised 10/29/04