Payment Processing Form

Payment Processing Form

Please complete the registration and payment processing form.
Your Name

First NameLast Name
Company Name
Your E-mail
example@example.com
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
File Upload

Upload Reference Letter and/or documentation of student status (unexpired student id, letter from school, transcript)
Cancelof
Name of ReferenceFirst and Last Name and email address of my reference isEmail address I authorize you to contact the person above for a reference connected to my membership application.

Signature- You authorize payment for the services indicated and understand all fees and dues are non-refundable.

Clear

Please process my payment for the service indicated below:

Application FeeApplication Fee to review and process application , non-refundable

$25.00

Student Associate Membership DuesPlease submit proof of student status or use a verified student email address, non-refundable

$50.00

Associate Membership Annual DuesAnnual Associate Membership Dues

$200.00

Associate Membership Renewal DuesOngoing Membership Dues, non-refundable

$150.00

Certification Training Fee (Tuition)CCEI and CPEI Training Fee

$200.00

Certification Exam FeeNon-Refundable Certification Exam Fee, non-refundable

$150.00

Certificate FeeNon-refundable fee for issuance of certification number and printed certificate

$10.00

Webinar (Virtual) Participation FeeRegistration fee for the 4-hour seminar. Includes fee for up to 5 participants. Certificate issued to up to 5 individuals.

$250.00

Webinar (In-person) Participation FeeNon-refundable fee per participant. Registration fee for the 4-hour seminar.- In-person

$100.00

Accreditation Application FeeNon-refundable application fee for accreditation

$100.00

Desk Review FeeNon-refundable fee for a desk review of the application for accreditation. This fee is not an application. This is a fee to review and audit

$500.00

Site Review FeeThis fee is per day. You will be notified if your institution requires a site review. Please select the number of days below.

$500.00 Quantity

Accreditation Annual Dues$1200-$3000 Please select from the drop-down menu

$1,200.00

Accreditation Binder Official Accreditation and Standards Binder with printed documents and instructions for application. Includes Shipping

$300.00

Enter coupon

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty: