Certified Installer Application

Complete, sign and submit this form 4 to 6 weeks prior to a certification event.

If you'd prefer to print this form and mail it to us with a check, click here.

Applicant Name

Certification Location to Attend

Years in the Trade

Company or Company Sponsor

E-mail

Work Phone (xxx-xxx-xxxx)

Cell Phone (xxx-xxx-xxxx)

Birth Date (xx/xx/xxxx)

Any languages other than English, in which you are fluent

Shirt Size
Large
X-Large
XX-Large

Address as it should appear on the NFIC web site

Address Line 1

Address Line 2

City

State

Zipcode

Work Phone (xxx-xxx-xxxx)

Cell Phone (xxx-xxx-xxxx)

Website Address

E-mail

Please insert your name and date below as a form of signature to this document.

Signature on this form verifies that the information on this page is true to the best of my knowledge. Any installer who does not pass has one year to return at an additional cost of $25.00 fee to complete the original categories. I understand that the testing will involve installation procedures and equipment common to the industry, including all risks associated with installation activities. As further consideration for this opportunity, I specifically agree to release NFIC, its officers or employees from any and all claims and specifically waive all such losses against the Association and such persons. In the event my activities cause injury or damage to any other person or entity, then I agree to fully indemnify, hold harmless, defend and protect the Association and all related persons from such losses, including any losses caused in part by the negligence of such others, I fully understand that failure to conduct myself in a responsible manner during the testing program may result in my termination.

Each year that you are part of this organization there will be yearly dues of $100.00.

Your Signature

Today's Date