BEAC Certification Examination Registration

Board of Environmental, Health & Safety Auditor Certifications

CERTIFICATION
Examination Registration

WHICH EXAMINATION ARE YOU REGISTERING FOR?
Environmental Compliance - I have submitted the required Application Health & Safety - I have submitted the required Application Management System- I have submitted the required Application Responsible Care® - I have submitted an Application for BEAC certification Responsible Care® - I want to take the exam only (Certificate of Attainment)

EXAM DATE & LOCATION:

Special exam date & location:

Last Name:
First Name:
Company:
Title:
Address:
City:
State:
Zip:
Country:
Work Phone:
Fax:
E-mail:

SELECT:
	Part 1 - fee is $100
	Part 2 - fee is $100
	Part 3 - fee is $100
	*Certificate of Attainment* - Responsible Care® Exam Only - $300
TOTAL EXAM REGISTRATION AMOUNT:

PAYMENT OPTIONS:
	CHECK, payable to BEAC (in US Dollars). For checks drawn on banks outside the U.S. and Canada, add $30 bank collection charge. For wire transfers, add $15 transfer free.
	Credit Card Payment

CREDIT CARD Information:
	Credit Card Type:
	Credit Card Number:
	Expiration:	/
	Card Holder's Name:

Please note that the information you send about your credit card is e-mailed directly to BEAC. This information is NOT encrypted. If you are concerned about this, please print this form and fax it to: 407-830-7495

Cancellation Policy - 24-hour advance cancellation notice is required. Registrants who fail to notify the BEAC office 24 hours in advance of the exam will be charged a $50 no show fee.

Comments: