Having a Listing Added to the Registry

Complete the Application

Complete the Registry of Pesticide Hypersensitive Individuals Application (PDF) or it can be obtained through your local pesticide businesses, or by contacting any Pennsylvania Department of Agriculture Regional Office. Individuals will be required to make arrangements with someone to be an alternate contact; this person must be willing to receive calls and forward the information on to you when applicators cannot contact you directly.

Complete the application using your legal address as your primary residence, daytime, nighttime and alternate telephone numbers. You must complete all required blocks or the application will be returned.

Part II

See your Pennsylvania licensed physician to have Part II of the form completed and signed. 

Return Address

Review your application for completeness and return it to:
Pennsylvania Department of Agriculture
Bureau of Plant Industry
2301 N Cameron Street
Harrisburg, PA 17110-9408