ASNT Level III Refresher Course Registration Form Jan/Feb 2018

E-mail ASNT ID

Last Name First Name

Company Name

Mailing Address

City State

Zip/Postal Code Country

Phone Fax

Course Dates
Courses Days CEUs Tuition (Circle dates you plan to attend) Amount
Visual (VT) 3 2.4 $1260 January 24-26, 2018
NDT Basic 5 4.0 $2100 January 29 -February 2, 2018
Ultrasonic (UT) 3 2.4 $1260 February 5-7, 2018
Magnetic Particle (MT) 2 1.6 $840 February 8-9, 2018
Radiography (RT) 3 2.4 $1260 February 12-14, 2018
Liquid Penetrant (PT) 2 1.6 $840 February 15-16, 2018
Registration Deadline
Cancellation/Transfer Deadline January 8, 2018 Total:

Payment Information
Form of Payment AmEx MasterCard Visa Discover Check Funds Transfer
Type of Card Personal Business

Account Number Exp. Date CIN*

Name on Card (Please Print) / Signature

Cardholder Information
Address, City, State, Zip, Country

Billing E-mail address

*Credit Card Identification Number. For Visa/MasterCard/Discover: The three-digit value is printed on the signature panel on the back of cards immediately
following the account number. For American Express: 4 digit, non-embossed number printed above your account number on the face of your card.

Payment must accompany this registration form. Forms received without payment will not be processed. ASNT will accept checks,
money orders, Visa, MasterCard, Discover, or American Express. Purchase orders are not acceptable. All foreign payments to ASNT
must be made in U.S. currency drawn from a U.S. bank. Make checks and money orders payable to ASNT.
For credit card payments fax to: 614.274.6899: For all other payments mail to: ASNT, 1711 Arlingate Lane, Columbus, OH USA
432280518
Registration Policies: Class size is limited. Registrations are processed on a first come, first serve basis. Registered students who
notify ASNT in writing of transfers or cancellations by the deadline listed below will be subject to a $100 cancellation/transfer fee per
method. Transferred courses must be taken within one calendar year of original payment. There are no cancellations or transfers
after the cancellation/transfer deadline. ASNT reserves the right to cancel any course. If ASNT cancels a course, a full refund of
tuition is available or tuition may be applied to future courses or other ASNT programs.

Lunch: ASNT Center for Excellence will provide lunch each day of the course. Please email kdonaldson@asnt.org for any food allergies
or special dietary restrictions.

Exam Registration: ASNT Center for Excellence offers Computer Based Testing for the NDT Level III exams following the Refresher
Courses. A separate examination application (including fees) must be submitted prior to the Refresher registration deadline. To register, visit
the ASNT website, https://www.asnt.org/MajorSiteSections/Certification/ASNT_NDT_Level_III.aspx