Printable form (certification) (PDF file)
Printable form (recertification) (PDF file)
A. Indicate your current certification by any of the following certifying boards.
B. Indicate your current membership in any of the following professional organizations:
C. Indicate current professional licensure or registrations, with dates awarded, and upload a copy of current license or registration (or fax to 414/276-2146).
D. Provide any additional comments which you feel would be helpful to CAOHC in considering your application.
If you are submitting online, you MUST read the following and agree by checking this box BEFORE you submit your application.
Signature (if submitting by mail or fax):___________________________________________
Registration fee due in full (7) seven days in advance of the workshop. Workshop registration fee includes: Continental breakfast, CAOHC Hearing Conservation Manual and all necessary course materials and handouts.
Seven days prior to the workshop, a full refund, with the exception of a $25 processing fee, will be made to any registrant who must cancel his/her attendance. After 7 days prior to the workshop, no refund will be made.
Candidates must be present for the entire course in order to be granted certification, recertification, and CEU credits.
How did you hear about the workshop?
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Submit online or print and fax (credit card orders only) or mail with payment to:
555 E. Wells Street, Suite 1100, Milwaukee, WI 53202-3823
Phone: 414/276-5338 Fax: 414/276-2146
FOR OFFICE USE ONLY:
Rec'd @ CAOHC Office:
Signature: __________________________________________ Date: ____________