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This registration form is for NHA Certification exam ONLY!!!

$105.00 for the exam - check or money order made payable to NHA
$  45.00 processing fee - cash or money order payable to MBCTI
Total cost of exam is $150.00 USD.

Students  MUST make payment "in full" at the time of exam.

Please fill in your information below.

First Name           

Last Name            

Address                

City                        

State                      

Zip Code               

Daytime Phone    

Evening Phone    

Class Date            

E-mail Address    

Please click on the Submit button when finished.

If you have any questions please call 214-328-1055

 
 

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