Registration Form for NATE Certification


1. Print this form.
2. Fill out all information.
3. Fax (if using credit card) to 301.384.9623 or 800.554.4448
4. Mail (if paying by check) to ACCA - NCC, PO Box 4268, Silver Spring, MD 20914
Check one technician type:
  Installation Technician
  Service Technician		 Check up to two exams:
Core
Air Conditioning
Air Distribution
 Gas Heating
Heat Pump
Oil Heating
Core Exam:

$95 per person (ACCA-NCC member)
$125 per person (non-member)

Core Exam consists of 50 questions/ Specialty Exams consist of 100 questions each.
Test timing for Core Exam and one Specialty Exam is a maximum of 4 hours.
Retests are given at a reduced rate (with proof of previous exam taken).

 Any Specialty Exam:

$115 per person (ACCA-NCC member)
$145 per person (non-member)

Photo ID will be required for entrance to exam site.
Discount of 10% given to group of 6 or more from same company.
Participant Name: (please copy this form and use separate form for each participant)
__________________________________________________________________

Company: ____________________________________

Address:   ____________________________________

City, State  Zip: _________________________________

Phone & Fax:    _________________________________

 Contact/Person CompletingForm:
_____________________________________________

Air Conditioning Contractors of America-National Capital Chapter

Payment Must Accompany Form:
(Circle ONE)


VISA        MASTERCARD        DISCOVER

AMEX          CHECK
$ Amount: __________________________________________

Card #      __________________________________________(only if paying by credit card)

Exp. Date __________________________________________

Name on Card ______________________________________