Cert App - CP3 TECHNOLOGIST -Updated Jan 2009Cert App - CP3 TECHNOLOGIST -Updated Jan 2009.doc

Cathodic Protection Certification Application CP 3 - Cathodic Protection Technologist (Must be submitted to NACE Headquarters for certification to be processed) Please Note – This Is Not A Class Or Exam Registration NACE Member: ( Yes ( No Member # Applicants Name: Home Address: Company Name: Company Address: Country: Zip/Postal Code: Phone: Home Business Fax E-mail: _____________________________ SIGNATURE: DATE: PRINTED NAME: REQUIREMENTS NECESSARY TO ACHIEVE CERTIFICATION To achieve this certification, qualified individuals have two options (see each option for prerequisites): CLASSROOM TRAINING –CP3-Cathodic Protection TechnoloistorEXAM ONLY OPTION - CP 3-Cathodic Protection Technologist Exam Only APPLICATION PROCEDURE It is strongly recommended that Exam Only candidates submit a completed application for certification at least 60 days in advance so that work experience requirements and education prerequisites can be verified. RECERTIFICATION REQUIREMENTS Every three (3) years. Recertification requires a minimum of 2 years work experience in cathodic protection and 8 hours per year (24 hrs total) of professional development hours. SUBMIT COMPLETED APPLICATION AND SIGNATURE PAGES TO: MAIL TO: NACE INTERNATIONAL OR FAX TO: 281-228-6311 CERTIFICATION DEPARTMENT 1440 SOUTH CREEK DRIVE HOUSTON, TX 77084 If you have any questions, please contact Marie Newton in our Certification department at 281-228-6211 or by e-mail at marie.newton@nace.org.  AFFIRMATION I affirm that: I understand that I am solely responsible for making sure that all necessary work experience documentation is complete and submitted in good order to NACE Headquarters. I understand that if I knowingly provide, or cause to be provided, any