Rac Ct Renewal Form

RAC Recertification Application Congratulations on maintaining your commitment to the regulatory profession by renewing your RAC. Please send your completed application to Mail RAC Program Office 5635 Fishers Lane Suite 550 Rockville MD 20852 USA Fax 1 301 770 2924 Email certification raps. org Receipt of your application and confirmation of your recertification status will be acknowledged within 20 business days. There is no membership requirement to renew your RAC. RAPS members and nonmembers will be evaluated equally on RAC renewal however RAPS members are entitled to a reduced fee for recertification. Additional information on recertification and other RAC requirements and policies is available at RAPS.org/RAC. Please read and carefully complete each relevant section below providing all required information. You may submit this application any time prior to 15 December of the year in which your recertification is due however all qualifying professional development activities must be completed at the time of submitting the application. The completed application and payment must be received by the RAC Program Office by 15 December. I acknowledge that should the RAC Program Office contact me to supply proof of reported activities I will respond within a reasonable amount of time not to exceed 30 days. Submitted with this application is a list of qualifying activities and related credits. If activities are tracked using RAPS Professional Development Manager see p. 3 please attach a print out of recorded activities. Signature Date This form is to be submitted by 15 December of the year due to recertify. Once approved recertification will continue on a three-year cycle. To receive this membership you must check the acceptance box here. Membership accepted METHOD OF PAYMENT Check o Money Order o MasterCard o Visa o American Express Credit Card No. Expiration Date Billing Address Zip/Postal Code Amount of Charge o 100 RAPS Member Fee o 310 Nonmember Fee o Other/ Late fee if applicable 50 pr yr late refer to Recertification Guide Name on Card Signature Forward application and payment to RAC RECERTIFICATION APPLICATION PAGE 2 TRACKING PROFESSIONAL DEVELOPMENT ACTIVITIES If you are a RAPS member tracking your professional development activities for maintaining your RAC is now a lot easier thanks to the new Professional Development Manager login required. Please send your completed application to Mail RAC Program Office 5635 Fishers Lane Suite 550 Rockville MD 20852 USA Fax 1 301 770 2924 Email certification raps. org Receipt of your application and confirmation of your recertification status will be acknowledged within 20 business days. APPLICATION CHECKLIST o Section 1 Applicant information* I completed the applicant information and noted the email address to which RAC correspondence should be sent. o Section 2 Payment. I included payment information with this application* o ection 3 Code of Ethics for Regulatory Professionals. I have read and acknowledge the Code of Ethics for Regulatory Professionals. S o ection 4 Professional Development Activities.