Nace CP 1 - Page 19

Cathodic Protection Certification Application
CP 1 - Cathodic Protection Tester
(Must be submitted to NACE Headquarters for certification to be complete)
NACE Member:  Yes  No Member #
Applicant's Name:
Home Address:
Company Name:
Company Address:
Country:
Zip/Postal Code:
Phone: Home
Business Fax
E-mail: _____________________________
PRINTED NAME:
I affirm that:
1. I understand that I am solely
responsible for making sure that all necessary work experience documentation
is complete and submitted in good order to NACE Headquarters.
2. I understand that if I knowingly provide, or cause to be provided, any false information in connection with my
recognition under the NACE International Training and Certification Program, that it will be grounds for
action against my understanding in the program.
3. I understand that the names of the categories within the NACE International Cathodic Protection Training
and Certification Program are as follows:
Highest Program Step Successfully Completed Category Name
CP 1 Cathodic Protection Tester
CP 2 Cathodic Protection Technician
CP 3 Cathodic Protection Technologist
CP 4 Cathodic Protection Specialist
4. I understand that the registration number and/or category title may be used only by Certified Cathodic
Protection persons (persons who have successfully completed CP 1, CP 2, CP 3 or CP 4). I understand
that this applies to business cards, stationery, advertisements, etc. I understand that in no case may the
NACE International logo, NACE International Cathodic Protection logo, or other NACE insignia be used. I
understand that violation of these rules will result in action against my standing in the program on the basis
of violation of the NACE International Cathodic Protection Program Attestation.
5. I (re)affirm the NACE International Cathodic Protection Certification Program attestation, reproduced on the
back side of this sheet, and agree to abide by its provisions as long as I hold any level of recognition under
the program.
Signed:
Date:
THIS DOCUMENT MUST BE SIGNED AND RETURNED WITH APPLICATION
RETAIN A COPY OF THIS DOCUMENT FOR YOUR RECORDS