Please complete the information below and then click "Submit."
 Your application will be sent to the ACI Certification Office and you will
receive an email acknowledging your submittal and offering an immediate
and secure payment option via credit card through PayPal. Please allow
several hours for the acknowledgement, since we verify there is class space
for you prior to sending you the email.  

Applicants Must Be Able to Lift 50 lbs.

Class and test time typically 8AM to 4PM.
Dress appropriately for concrete testing (heavy shoes and long pants).

Payment and Notification

When your payment is received, your place in the class
will be reserved. Two weeks prior to the class, you will be emailed directions
and instructions.   

IMPORTANT Fees for “no shows” are forfeited and are NOT REFUNDABLE
without 5-day notice prior to the class session date.
Please read our "Frequently Asked Questions" document for very important
details on our refund and rescheduling policies.

Use your mouse or the tab key to help fill out the form.
All boxes below must be filled in.

The "Email Contact" address below will be used to send out the
directions to the class and if we have billing
and other questions. Thank you.

1. Applicant and Class Information

STUDENT NAME:
 BILLING EMAIL:
STUDENT EMAIL:
SESSION ID # FROM SCHEDULE:
SESSION LOCATION:
YOUR EMPLOYER:
MAILING ADDRESS:
CITY, STATE AND ZIPCODE:
DAYTIME TELEPHONE:
EVENING TELEPHONE:
FAX NUMBER:
2. Select Course and Indicate Total Fee

Contact the Certification Coordinator for availability
of other types of Certification offered.
TWO-DAY FIELD TECH 1 COURSE -- $375.00
RECERTIFICATION FIELD TECH 1 COURSE -- $375.00
RETEST FT1 WRITTEN ONLY -- $195.00
RETEST FT1 PERFORMANCE ONLY -- $225.00
CONCRETE STRENGTH TESTING TRAINING + EXAM -- $375.00
CONCRETE STRENGTH TESTING EXAM ONLY -- $315.00
AGGREGATE TESTING TECH - LEVEL 1 EXAM ONLY -- $415.00
AGGREGATE TESTING TECH - LEVEL 2 EXAM ONLY -- $415.00
LABORATORY TESTING TECH - LEVEL 2 EXAM ONLY -- $415.00
AGGREGATE BASE TESTING TECH EXAM ONLY -- $415.00
TOTAL FEE:
 

3. If Paying by Credit Card

After verifying space in the class you sign up for, our Certification Coordinator Liese Hironaka will send an email to the address
you provided with a link to a secure site through PayPal
for online credit card payment.

 You may contact Liese directly at (800) 753-7711
with card information, but we prefer you use PayPal since it
provides better security for your transaction.

4. Before You Submit Your Application
Read the Information Below the SUBMIT FORM Button.



Carefully review your information for accuracy.

 When you click "SUBMIT FORM" your application will be sent
and you will receive an email acknowledgment from the
Certification Coordinator with the option to pay by credit
card using PayPal on a secure website.

After you submit this form, you will be shown the information you provided
to us. When you click the link to return to the website, you will return
to the Certification Schedule page.

If you are paying by check, please promptly
send payment to the ACI Certification Program.

Your registration in a class depends upon payment
being received for that class.

All paid students for 2012 classes receive a
complimentary membership in the
Northern California & Western Nevada
Chapter of ACI.
  

Thank You for Applying!

Make Checks Payable To:
Northern California & Western Nevada Chapter, ACI

Mail Checks and Make Inquiries To:
Liese Hironaka / ACI Certification Program
certification@aci-ncawnv.org
Phone: 800-753-7711 
Fax: 916-689-8093
Post Office Box 2393
Elk Grove, California 95759