Change of Status Application
To apply for retired or disability status, a member must be active and in good standing. They will receive limited AMT member benefits, including online-only access to AMT Pulse.
Member Name
*
First Name
Last Name
AMT ID number
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Certifications (click all that apply)
*
RMA
MT/MLT
RPT
CMAS
RDA
CLC
AHI
CMLA
MDT
PCT
Change of status being requested:
Retired - To qualify member must not be currently working and must be 65 years of age or older. Documentation from an official source, such as the Social Security Board or written evidence from your employer must be submitted for approval.
Disability - To qualify member must not be working at all due to a disability/ illness or injury classified as either permanent or long term with a duration of no less than a year. Documentation of circumstances from a physician is required either every three years or prior to the end of each 3-year cycle to maintain your status. If applying based on long-term disability, the physician must indicate the anticipated timeframe until recovery.
Supporting Documentation
Browse Files
Please attach either PDF, jpg or word documents files as documentation.
Cancel
of
If unable to attach documentation electronically, please confirm that you will mail documentation within 30 days of this form being submitted.
Submit via USPS mail
Optional comments
By clicking this box below, I am agreeing to electronically sign this document and I attest to this information being correct. In addition, should my status change, I agree to contact AMT to bring my certification back to an Active and Certified Status and resume all requirements necessary to maintain certification, including payment of the full annual renewal fee and compliance with the Certification Continuation Program (CCP), if required.
*
Agree
Submit
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