Mosquito Spraying Avoidance Request

2. 

4. Mosquito Spraying Avoidance Request
   I DO NOT wish for my property to be included in the adulticiding (ground spraying) service provided by mosquito control using a vehicle mounted ultra-light volume (ULV) spray machine for the following reason(s):

   I DO NOT wish for my property to be included in the adulticiding (ground spraying) service provided by mosquito control using a vehicle mounted ultra-light volume (ULV) spray machine for the following reason(s):

6. Reasons:

   1. Beekeeper

   1. Allergic to pesticides

   1. Other (Please Explain)

8. Other (Please Explain):

10. I understand that a new release form must be obtained from, completed, and returned to Mosquito Control each calendar year.

12. Name:*

13. Phone:*

15. Address:*

17. Email Address:

19. Electronic Signature:*

20. Date:*
    Date:

Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field