Registered Chemical Applicator – Application for Revalidation * Items with an asterisk may be published on the GROWSAFE® website register of RCAs.

Your Details (Home address, email and phone number requested so that we can still contact you in the event you change employer before your next revalidation.)

First name *

Second name(s)

Surname *

Home address

Work email address *

Personal email address

Work phone number *

Home phone number

Mobile phone number *

Your Company/Employer

Employer/ company name *

Physical address (for site visit)

Postal address (for invoice)

Company website *

Main activity* (eg roads and reserves, biosecurity, pastoral weed control)

Certification Requirements

GROWSAFE® RCA number* R

Approved Handler certificate number and expiry date