Registration for Proctored 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:
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
First & Last Name:
S.S. # / NITC ID #/ UA ID #:
Address:
City:
State:
Zip:
Cell/Other Phone:
Email:
The fee is $99.00 per recertification 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 (877) 457-6482. If payment is made by phone the form must be received via fax or email medgascerts@nationalitc.com beforehand. For Refund Policy refer to the Rules and Procedures.
To locate a Prometric Test Center, go to Prometric ProScheduler. Login information for scheduling the examination date and time will be provided via email from NITC to the email address provided above within 2 to 3 business days. Registration Forms will not be processed until payment is received.
Please note: Candidates may reschedule or cancel 30 days prior to the appointment with no fee. Candidates who reschedule or cancel within 5-29 days will be charged a $35 fee. Candidates rescheduling or cancelling less than 5 days prior will be charged a $50 fee and must contact NITC to obtain a new eligibility.
Signature of Applicant:
Date:
Attach all documents that apply: