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Please complete this PCI training application by neat
printing and legible black ink, along with your signature,
and send to PCI by email attachment to:
moldconsultant@yahoo.com, or
FAX it [inside USA] toll-free to
1-877-572-5724, or outside of the USA to USA fax number
973-297-2860
Full
name:___________________________________________________________________
Mailing
address:______________________________________________________________
___________________________________________________________________________
City:_____________________________ State: ________________ Zip Code:
___________
Country:____________ Daytime phone: (________ )_________________________
Evening
phone: (_______)_______________ Email
address:___________________________
Designation [s] I desire [upon successful
completion of each certification designation training program]---:
____ Certified Mold
Inspector---tuition $499.00 plus first year membership
certification dues in PCI of $49.00 for a total of $548.00
____
Certified Mold
Remediator--tuition $499.00 plus first year membership
certification dues in PCI of $49.00 for a total of $548.00
____
Certified
Environmental Hygienist--tuition
$499.00 plus first year membership certification dues in PCI of $49.00 for
a total of $548.00
____
Certified Water Leak
Locator--tuition
$499.00 plus first year membership certification dues in PCI of $49.00 for
a total of $548.00
____
Certified Waterproofing
Pro--tuition
$499.00 plus first year membership certification dues in PCI of $49.00 for
a total of $548.00
____ Combo #1: These
FOUR courses:
________________________________________________________
for the price of $1,497, plus US$196
first year membership certification dues in PCI for four
designations, for a total of $1,693.
____
Combo #2: ALL FIVE courses for the price of $1,996, with
a waiver of my
first year membership certification dues in PCI for all five
designations
All payments are in US$ or the equivalent value of another widely-accepted
currency.
If I am
accepted by the Professional Certification Institute, I, and the
organization that I may represent, will always follow and abide by the
Code
of Ethics of P.C.I. I understand and agree that my professional
designations will be terminated if I violate the Code of Ethics, or if I
do not pay my annual renewal PCI membership dues [currently $49.00 per
certification designation]. To accompany this training application, I will process a payment to PCI
using one of the Payment Options listed at the bottom this page, or by my
check.
If
you have completed ANY post-high school college, trade, or
technical education programs of any kind, please provide the details
including school name, school location, year of graduation or completion
of course, subjects studied, and any other helpful info. Attach extra
sheets of paper if needed.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Please describe in detail all
or your business/work/career experiences that you believe would be helpful
to your successful career as a certified environmental professional.
[please include details such as skills learned, employer names and
addresses, and dates]. Attach extra sheets of paper if needed.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Please provide the names,
nature of relationship [how you know each person], company [if relevant],
complete mailing address, and current phone number of at least three
persons who personally know your work abilities and/or general character.
Your most ideal references would be your business/professional clients or
co-workers. Please do NOT submit references who are your relatives or
employees. Attach extra sheets if needed.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
I
certify that the above information is totally true and complete. I
authorize my references to provide complete information about myself to
the Professional Certification Institute.
___________________________________
____________________
My
Signature
Date
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