Application for Certification

WHICH CERTIFICATION ARE YOU APPLYING FOR?

Application fee - $95 per certification program

Environmental Compliance Auditor Certification

Health & Safety Auditor Certification

Management System Auditor Certification

Responsible Care® Auditor Certification


Title (Mrs., Mr., etc.):
Last Name:
First Name:
Middle Initial.:
 
E-mail:
HOME Address:
City:
State / Province:
Zip:
Country:
Phone:
Mobile Phone:
 
Company / Organization:
Title / Position:
BUSINESS 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:
Business Home

Are you a member of:
Yes
No
The Auditing Roundtable?
The Institute of Internal Auditors?
ASSE?
AIHA?

EDUCATION - minimum of Bachelor's degree required for certification
Highest Degree Achieved: Name of Awarding Institution:

PAYMENT

Check, payable to BEAC (in US Dollars).

Please mail check to 247 Maitland Ave., Altamonte Springs, FL 32701 USA. For checks drawn on banks outside the U.S. and Canada, add $30 bank collection charge.

A $25 processing fee will be charged for any returned check
Wire transfer: Contact the office for wire transfer information. For wire transfers, add $40 transfer free.
Credit Card Payment

Credit card information :
Credit Card Type:
Credit Card Number:
Expiration:
/ 
Card Holder's Name:

PLEASE NOTE: the information you send is e-mailed directly to BEAC, and is NOT encrypted. If you are concerned about this, please print this form and fax it to 407-830-7495.

ACKNOWLEDGEMENT:
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: