Medical Gas Recertification Examination 

 All exams are administered online via Prometric Test Centers. Results are provided at the completion of the examination. It is the applicant’s responsibility to obtain the necessary material to take to the Prometric Center. 

Please complete all information below: (*Required Fields*)
I have taken a minimum of (4) hours training to the current NFPA edition. Please include a copy of your “certificate of completion” or verification with this registration form.
*Name:
*S.S. # / NITC ID #/ UA ID #:
*Address:
*City:
*State:
*Zip:
Phone #:
Local No (if applicable):
E-mail:
*Please Check One:
The fee is $60.00 per re-certification examination. Please make check or money order payable to NITC. Visa, MC or Amex are also accepted. Note: In some cases, payment is provided by the training agency or employer. Method of Payment must be included with form or call to pay by phone at (888) 234-6834. If payment is made by phone the form must be received via fax or email maintenance@nationalitc.com beforehand.
Once payment has been received, you will receive an email from NITC within 2 to 3 business days with your online login information.
Signature of Applicant:
Date: