ACMG Verification of Course Participation & Certificate Request v2024

Verification of Course Participation & Reissue of Certificate Request
Purpose of the Form:

The form is meant for individuals who wish to obtain a copy of a credit/participation certificate from ACMG Education.

Verification Process:

ACMG Education will verify the attendee's presence and the credits being requested.

Genetic Counselors:

Genetic counselors should contact NSGC (National Society of Genetic Counselors) for their certificate instead of using this form.

Charges for Non-Members:

Non-members seeking educational credit verification or reissuance of a certificate will be charged an administrative processing fee.

Payment Instructions:

Submit one payment per course.

Processing Time:

Requests will be electronically processed within two weeks after payment. The exception of 3-4 weeks processing for requests made in March due to workload demands for the ACMG Annual Clinical Genetics Meeting. Verification and Reissue of Credit Certificates will be emailed.
Participant Information*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
Certificate Type(Please Select One)*
Course information:*
Payment Information
Purchaser Name*

First NameLast Name
Purchaser E-mail*

My Products

ACMG Education Administrative Processing Fee$40.00

Non-members must pay fee.

Total $0.00

Payment Method
Credit	Express

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Should be Empty: