ASNT Identification Number
If you have previously been given an ASNT identification number, please enter it in this box:
Personal Data Mail certification information to:
Mail membership material to: Name Home
__x_Mr ___Miss ___Mrs ___ Ms
CARLOS ENRIQUE SUAREZ NAVAS
Print your name as you wouldlike it to appear on your certificate: First, Middle or Middle Initial, Last CRA 17B No. 175-91. RINCON DE LA ALAMEDA. TORRE 3. APTO. 801 Address BOGOTA City 5716702893 Phone CUNDINAMARCA State/Prov. 5716702893 Fax 11001000 ZIP/Postal Code Csuarez.email@example.com Email * COLOMBIA Country
TECNICONTROL S.A. Organization Name Autopista Norte Km 19, Costado Occidental Address CHIA City571-6671444 Phone CUNDINAMARCA State/Prov. 571-6760794 Fax 11001000 ZIP/Postal Code firstname.lastname@example.org Email * COLOMBIA Country
Fees All fees are in US dollars.
Basic Examination Total Method Examination Total International Mailing Surcharge Membership Option
* Please check which email is primary. This email will be used for all correspondence.
Save on certification fees now by becoming an ASNTmember. See page 8 for all the benefits members enjoy. From page 2 From page 2 For all non-US Residents $40
385 40 425 425
Take advantage of member pricing now by completing the membership application on pages 8 and 9 and include the total here.
Total Fees Less transfer in (if applicableinclude copy of transfer letter)
Payment must accompany application Check Funds Transfer MoneyOrder Discover Visa MasterCard American Express
Make payable to ASNT (must be drawn on a US bank) JPMorgan Chase, NA ABA # 044000037 Swift Code: CHASUS33865 Account # 981027205
Total Due Personal Credit Card Card Holder’s Name (please print) CARLOS E SUAREZ N Credit Card Billing Address CRA 17B No. 175-91. RINCON DE LA ALAMEDA Card Number 5417 1300 0039 0667 Expiration Date 09 / 13 CardHolder’s Signature
Company Credit Card
CIN Number* 019 Date June 1, 2010
*Credit Card Identification Number: Visa/MasterCard/Discover: The three-digit number is printed on the signature panel on the back of the card following the account number. American Express: The four-digit number is printed above the account number on the front of the card. app-l3-mexi-6a Page 1 of 9 Rev. 04.28.09Examination Scheduling
This application is valid only for ASNT examinations held by the Mexico Section, an ASNT Local Section. Use the tables below to designate the examinations you would like to take. Please observe the application deadline date for the examination location and dates you are choosing. All exams are conducted in the English language. Note: This application is valid for initialcertification and for recertification by examination. To renew without further examination (by points), you must use the ASNT Level III Renewal Application.
Location and Dates
To apply for an exam, enter the date and time when you’d like to take the exam. Exam Location: dates are listed in the ASNT Examination Schedule. Only one examination may be taken Mexico in a session. You may take a maximumof two (2) examinations per day at a scheduled test site. Check a box indicating if this is a new or added method, a retake of an exam that you failed within the last five years, or a recertification exam if you are currently certified in the method.
First time applicants must take a Basic examination. To become certified as an ASNT NDT Level III in any method, the NDT Basicexamination and the method examination must be passed. To become certified as an ASNT PdM Level III, both the PdM Basic examination and the IR method examination must be passed.
Time Exam NDT Basic PdM* Basic
*PdM Level III certification is available only in IR. NDT Level III certification is available in all 10 methods.
New $460 Retake $385
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