NAFA NCT (Level I & II) renewal form (nonmembers) - National Air Filtration Association

The following application must be completed and signed by December 31, 2022. Upon acceptance of the application, and appropriate fee, a 2023 NCT Certificate will be issued. NOTE: Please read all instructions carefully, failure to complete all sections correctly will result in a delay in the application processing and subsequently the charge of a $50 late fee.

Section 1: Applicant Informaiton

Name

First Middle Last Suffix

Company Name

Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone Number

Section 2: Qualifier

Any individual who is unable to answer the following question in the affirmative must retake the NCT exam in order to renew certification. Have you been actively involved in the sale/service of air filters during the past year?

Yes or NO*

Yes

SECTION 3: Continuing Education Requirements

To maintain NCT Certification, you must complete ONE continuing education credit per year from the categories listed below. This activity must have been completed between October 1, 2022 and September 30, 2023.

Choose one:*

Please describe below which activity you completed in order to satisfy the continuing education requirement for NCT renewal as specified. Please include the date and location for meeting attendance, or the name of publication and date your article was featured:*

SECTION 4: NCT renewal fees

By signing this document, the Applicant affirms having completed sufficient credits (as listed above) to maintain the NCT certification. Further, Applicant agrees to keep proof of attendance at NAFA approved functions on file for at least one year from the date of this application and further agrees to allow NAFA, at anytime within that year, to request proof of attendance. Failure to provide proof of attendance will result in immediate suspension of all certifications.

SECTION 5: Official Signatures

I have reviewed this application and attest that all information contained herein is correct and true. I understand that any misrepresentation is subject to disciplinary action by the NAFA Board of Directors including but not limited to revocation of certification and/or termination of membership.

Signature

Name*

First Last

By entering your name, email and company name, you are signing this document.