Professional Documents
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Burn Boss Form
Burn Boss Form
Burn Boss Form
Contact Information1
Last Name* Cummings First Name* James MI. R
Personal Telephone Number with Area Code Business Telephone Number with Area Code*
(813)855-9437 (813)907-9500
Have you ever received an acreage authorization If Yes, please provide your customer number
from the FFS? Yes No ✔
Please fill out this form and email it to the course coordinator. Once this form has been received and processed,
you will receive a package in the mail with course materials and an invoice.
Once you have received the package and are ready to begin the online portion of the course, please notify the
course coordinator so they can activate your online account.
*Required Fields
1 – Contact Information – Please provide your legal name. The address must be able to receive mail from the US
Postal Service
2 – Burn History – Please include the most recent burns which for which you were a participant or conducted. A
minimum of three burns must be provided to be eligible for this course.
FDACS-11621