NHCLP Recertification Application Recertification Year 2003 Earning period is January 1 – December 31, 2022 Must Be Received by January 15, 2023 to Remain Active Name* Email* Address* City* State* Zip Code* Certification #* Cell Phone #* HiddenPAID AMOUNT HiddenPAID DATE HiddenCREDIT CARD FEE NHLA Membership or Employment (Max 1 pt./year)Membership in NHLA or employment by a Horticultural based business Name of the member firm or business: Attendance at an NHLA Full-day Conference (2 pts./day)Attendance at an NHLA sponsored full-day conference (inc. Winter & Spring conferences; not Twilight meetings) List meeting(s) and date(s):Attendance at Twilight or Dinner Meeting (1/2 pt./meeting)Attendance at any NHLA Twilight meeting or Dinner meeting List meeting(s) and date(s):Service to NHLA Office or Committee member (1 pt./year)Service to NHLA as an officer or committee member List position or committee:Constructive Feedback (1 pt./review period)Provide constructive feedback during Certification Manual reviews. List chapter(s): State Pesticide License (1 pt./year maximum)State Pesticide License that requires earned educational credits List certification, certification #, and provide evidence: Published Articles (1 pt. each)Published articles in landscape or horticultural journals or NHLA Newsletter (not in a company newsletter) Submit/attach copy of article(s): Instructor (1 pt./credit hour)Instructor in higher education courses in horticulture. List institution and course, provide evidence:Student in Higher Education (1 pt./credit hour)A student in higher education courses in horticulture/or NHLA Plant Identification Course (4 credits) List School & Subject(s), provide evidence:Teaching Courses (1 pt./course)Teaching training/short courses (six hours or more) List institution and course, provide evidence: Speaker (1/2 pt./talk)Speaker at professional associations’ meetings (including NHLA), lectures, panel discussions, twilight meetings or related association meetings. List programs(s) and date(s), provide evidence: Attendance - Workshop (1 pt./day) prorate points for workshops < 1 dayAttendance at accreditation workshops sponsored by a related association. E.g. MNLA, MELNA, NOFA Organic Landcare, ELA, APLD, ISA, University Extension. List program(s) and date(s), attach Certificate of Attendance for each: Attendance - Webinar (1/2 pt./2 hours - 1/2 point MAXAttendance at accreditation workshops sponsored by a related association. E.g. MNLA, MELNA, NOFA Organic Landcare, ELA, APLD, ISA, University Extension. List program(s) and date(s), attach Certificate of Attendance for each: Attendance - Trade Show (1/2 pt./day) prorate points for workshops < 1 dayAttendance at landscape industry trade shows (Educational talks and workshops should be listed above.) List association(s), provide evidence: Personal Membership (1/2 pt. per membership - Up to 1 point)Each personal membership in another related professional association List association(s), provide evidence:Membership Related Association (1/2 pt./year)Service to other related professional associations as an officer, board member or committee chair List association(s) and role(s), provide evidence:Horticultural Community Service (1 pt./day) prorate points for workshops < 1 dayHorticultural Community Service List program(s) and date(s), provide evidence: Certified CPR, First Aid or Other Safety Course (1 pt./day) prorate points for workshops < 1 dayCertified CPR, First Aid Course or other industry specific safety training List program(s) and date(s), provide evidence: OTHER (1 pt./day) prorate points for workshops < 1 dayOTHER List pre-approved credit opportunities and provide Certificate of Attendance or other evidence: Upload a file with additional informationYou may upload additional information here. Document types accepted are doc, docx, or pdf. Max. file size is 2 MB.Accepted file types: doc, docx, pdf, Max. file size: 2 MB.Upload a file with additional informationYou may upload additional information here. Document types accepted are doc, docx, or pdf. Max. file size is 2 MB.Accepted file types: doc, docx, pdf, Max. file size: 2 MB.Upload a file with additional informationYou may upload additional information here. Document types accepted are doc, docx, or pdf. Max. file size is 2 MB.Accepted file types: doc, docx, pdf, Max. file size: 2 MB.Upload a file with additional informationYou may upload additional information here. Document types accepted are doc, docx, or pdf. Max. file size is 2 MB.Accepted file types: doc, docx, pdf, Max. file size: 2 MB.Recertification Payment* Recertification payment $40 Emeritus payment $20 PAYMENT METHOD*Make checks payable to NHLA. Send to Pam Moreau, Recertification, 13 Rancourt St., Nashua, NH 03064 If you need an invoice, please email Pam at nhla@comcast.net to request one. Pay by CHECK Pay ONLINE by Credit Card or PayPal Pay by INVOICE When paying by check, make your check out to NHLA and send to: Pamela Moreau, NHLA Business Manager, 13 Rancourt St., Nashua, NH 03064You can request an invoice by emailing Pam Moreau at nhla@comcast.net.Pay ONLINEPayPal CheckoutCredit Card American ExpressMasterCardVisaSupported Credit Cards: American Express, MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name Total $0.00 PhoneThis field is for validation purposes and should be left unchanged.