NATIONAL COMMISSION ON ALLIED HEALTH CERTIFICATION
CERTIFICATION RENEWAL FORM
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NATIONAL COMMISSION ON ALLIED HEALTH CERTIFICATION CERTIFICATION RENEWAL FORM

NATIONAL COMMISSION ON ALLIED HEALTH CERTIFICATION
NATIONAL PARAMEDICAL ASSOCIATION INC.
643 PALISADE AVENUE (SUITE L)
YONKERS NY 10703


CERTIFICATE NUNBER                                                       PROFESSION


APPLICATION FOR  RENEWAL OF ADVANCED ALLIED HEALTH CERTIFICATE

LAST NAME________________________________   


  FIRST________________________________

CERTIFICATE NUMBER_______________________________________________

PROFESSION_______________________________________


MESSAGE?______________________________________________________________________________

_______________________________________________________________________________________

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RENEWAL 1 YEAR:$90        RENEWAL 2 YEARS: $180
DO NOT SEND CASH IN THE MAIL MAKE CHECK/MO PAYABLE TO
NPA INC.

STREET AND NUNBER___________________________________________________

CITY____________________________STATE_________________ZIP_________________

print and mail this renewal form

FEES: 2 YEAR RENEWAL $180
         1 YEAR RENEWAL $90

IF A CERTIFICATE HAS EXPIRED FOR OVER TWO YEARS, A RE-INSTATEMENT FEE OF $25 MUST BE INCLUDED.
PROOF OF CONTINUING EDUCATION CREDITS OF AT LEAST 5 HOURS EVERY 2 YEARS MUST BE AVAILABLE (2.5 HRS/YR) IF REQUESTED. DO NOT INCLUDE CME CERTIFICATES WITH RENEWAL FORM.

ALLIED HEALTH COMMISSION QUALITY ASSURANCE
(914)377-1191