Application for Certification

WHICH CERTIFICATION ARE YOU APPLYING FOR?

Management System Auditor Certification - $245 application fee

Environmental Compliance Auditor Certification - $245 application fee

Health & Safety Auditor Certification - $245 application fee

Responsible Care® Auditor Certification - $245 application fee

FIRST TIME APPLICANT - Include the First Year Annual Certification Fee - $150.00

All fees are quoted in U.S. dollars


Title (Mrs., Mr., etc.):
Last Name:
First Name:
Middle Initial.:
 
E-mail:
HOME Address:
City:
State / Province:
Zip:
Country:
Phone:
Fax:
 
Company / Organization:
Title / Position:
WORK Address:
City:
State / Province:
Zip:
Country:
Work Phone:
Fax:
How did you hear about BEAC:
  (Brochure; Conference; Beac Website; Other Website; Referral (name); Other Organization)

Industry Code: Job Code:

Send mail to:
Office Home

Are you a member of The Auditing Roundtable, Inc.?
Yes No

Are you a member of The Institute of Internal Auditors?
Yes No

EDUCATION:
Highest Degree Achieved: Name of Awarding Institution:

WORK EXPERIENCE:
Number of years of relevant experience
Number of Equivalent Work Days of Environmental or Health & Safety Auditing
Number of Environmental or Health & Safety Audits Conducted
Number Hours of Formal Training

PAYMENT
Check enclosed, 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. (A $25 processing fee will be charged for any returned check)
Credit Card Payment
Charge 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 Customer Service at Fax No.:407-830-7495

CERTIFICATION:
Certification: By signing and submitting this form, I hereby certify that all information on this application is true and correct. If accepted, I agree to abide by the provisions of BEAC Code of Ethics and the conditions set forth in the BEAC Certified Professional Environmental Auditor Program
   
Full Legal Name: Date: