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*

If facility type is OTHER, please describe

Business Address*

Street Address Address Line 2 City State ZIP Code

Distributor*

Your CIVITAS TURF DEFENCE™ distributor

Rewards Survey

# Of Years Of Experience As A Superintendent*

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*

What Products Do You Frequently Add To Your Tank Mix To Improve Turf Quality?*

You can select multiple items

How Many Applications Have You Made Of CIVITAS TURF DEFENSE This Year?*

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 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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