Field Certified Professional Association® (FCPA®)

8241 Georgia Ave, Suite 100, Silver Spring, MD 20910 USA
Phone: (301) 587-7504                  Fax: (301) 587-5888
E-Mail: membership@FieldCertification.org

Fast-Track Membership Application Form

Contact information:

Mr.  Mrs.   Ms.   Miss.   Dr.  

Salutation

First Name

Middle Name

Last Name

Organization Name

Title

Street Address

 

 

 

City

State/Province

Zip/Postal Code

Country

Phone

Fax

E-mail Address

Web Address

By completing FCPA's membership application you will be provided with up-to-date information regarding Association activities, benefits and services. FCPA® may also make your mailing and e-mail address information available to other FCPA® members and service providers wishing to inform you of special member offerings. If you DO NOT wish your mailing and e-mail address to be disclosed to third parties, please check the box shown here. 

 

 

Organization Description:

 

Please provide a description of your organization's products/services in 50 words or less:

 

 

 

Current Certification(s):

 

Certification

Date Received

Date Received

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Direct Experience:  

Date(s)

Position

Organization

Responsibilities

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

References  (at least 3 references must be supplied)

Name

Position

Organization

Telephone

e-Mail

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Important note: You must provide copies of the certifications for which you are seeking Fast-Track certification.

Certification(s) You Are Applying For:

  FCPT    CNE /FCP    CNA/FCP      CCNA/FCP      FCSA for NT      FCSE for NT

Other (specify) ___________

Special Fees for Fast-Track Exams:

(Effective from July1, 2001 through December 31, 2002)

The fees are based on the length of the test.  All fees listed below are for a single test.  You may register for as many qualifying and available tests as you wish. 

Test Length (Hours)

Non-Members*

FCP™ Individual Members

Academic Members

Corporate

Members

Association

Members

1

$195

$155

$145

$135

$135

2

$295

$255

$245

$235

$235

4

$495

$455

$445

$435

$435

*  Non-members fees also apply to Basic Individual members.

Fee Enclosed: $________

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                Signature                              Name                                                                        Title                                                          Date