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Civitas Turf Defense ™ Rewards User Registration Form
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2017-03-20T15:17:40-05:00
Civitas Turf Defense ™ Rewards User Registration Form
Registration Information
Name
*
First
Last
Job Title
*
Business Phone
*
Cell Number
Email
*
Secondary Email
*
Please provide an alternative email address that we may use to contact you.
Business Name
*
Facility Type
*
Choose here
Golf Course
Sports Field
Other
If facility type is OTHER, please describe
Business Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
ZIP Code
Distributor
*
Your CIVITAS TURF DEFENCE™ distributor
Rewards Survey
# Of Years Of Experience As A Superintendent
*
Choose here
1-5
6-10
10+
Primary Type Of Turf Grass On Facility
*
Kentucky Bluegrass/Rye
Kentucky Bluegrass/Poa
Tall Fescue
Bermuda Grass
Bent Grass
Perennual Ryegrass
Zovsia
Other
If Other, Please Describe
Primary Turf Challenges
*
Drought/Water Reductions
Wear
Wear Recovery
Colour Retention
Disease Control
Other
If Other, Please Describe
Please Check Your Top Three Turf Concerns
*
Drought/Water Reduction
Wear & Tear
Insects
Playability
Esthetics
Other
If Other, Please Describe
Number Of Plant Health Product Applications Per Year
*
Choose here
1-5
6-10
11-15
More Than 15
What Products Do You Frequently Add To Your Tank Mix To Improve Turf Quality?
*
Heritage
EcoGuard
Emerald
Daconil
Segway
Rubigan
Prodigy
Chipco
Iprodione Pro
Mancozeb
Subdue
Tourney
Eagle
Defend
Penstar
Terraclor
Vital
Spectator
Honor
Affirm
Insignia
Proturf
Rhapsody
Banol
Torque
Soectro
Stellar
Turfsheild
Armada
Banner Maxx
Trinity
Turfcide
Propiconazole Pro
Triton
Reserve
Tartan
You can select multiple items
How Many Applications Have You Made Of CIVITAS TURF DEFENSE This Year?
*
Choose here
1-5
6-10
11-15
More Than 15
Where Do You Primarily Apply CIVITAS TURF DEFENSE?
What Primary Benefits Have You Noticed With CIVITAS TURF DEFENSE
Shipping Information
Please indicate the address you would like us to send your rewards gifts to
*
Same as Business address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
ZIP Code
Civitas Turf Defense ™ Rewards Program Rules & Regulations
*
Please contact me regarding my points balance and news about the Civitas Turf Defense ™ Rewards program. By registering for the Civitas Turf Defense ™ Rewards Program you are confirming that your management has provided permission to participate; and that you have read and agree to the
Rules and Regulations
of the Civitas Turf Defense ™ Rewards program.
Yes
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