ACI Grade 1 Field Technician Application October

Grade 1 Field Technician Application
Full Course Registration
For New or Re-Certification

October 2024

This form is for full course registration only. 
Written Exam Re-Take Application
Practical Exam Re-Take Application

Date M/D/YY *
Month of Class: *
Select your company from the list of CCPC Members below. If your company is not listed, please select "Non-Member", type in your company name in the next field, and select non-member pricing when completing your registration. *
Company:
Company Contact Email: *
Company Phone Number: *
Applicant Name: *
Email: *
Cell Phone #: *
Street Address: *
City: *
State *
Zip Code: *
Full Course Registration: *

Clear Selection

                                  

New certification? *

Clear Selection
Textbook and Exam Language: *

Clear Selection
Will you be attending the lecture in person or on WEBEX? (In person lectures are limited to 15 registrants.) *

Clear Selection

Please calculate your total payment:

    CCPC Member or Non-Member class cost
+  In person Attendance Fee (if applicable)
+  Spanish Textbook & Exam Fee (if applicable)
= Total Due Below

Please note WEBEX links are sent to all students regardless of their registration status.  The link is intended as a backup for those who have registered to attend in person, who may for whatever reason not be able to make it in.

Total Payment Due: *

Credit Card Payment Button will be provided after this form is submitted.

A Re-Application fee of $150 is applicable for any changes that may occur up to 2 weeks prior to the lecture.

All Re-Application requests must be submitted at least 2 weeks prior to the class for approval.







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Fields marked with * are required.

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