BEAC Certification Examination Registration

Board of Environmental, Health & Safety Auditor Certifications

CERTIFICATION
Examination Registration

WHICH CERTIFICATION ARE YOU REGISTERING FOR?
Management System Environmental Compliance Health & Safety Responsible Care® Responsible Care® - Certificate of Attainment - Exam only

EXAM DATE & LOCATION:

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

SELECT:
	1st exam - NO CHARGE - included in Application Fee.
	*Certificate of Attainment* - Responsible Care® Exam Only - $300
	I am RETAKING the examination. A $100 examination retake fee is enclosed.

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.

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