NGICP Train-the-Trainer

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One Time Credit Card Payment Authorization Form

By completing and submitting this form, you authorize Water Environment Federation to charge your credit card for the amount listed below. This is permission for a single transaction only and does not provide authorization for any additional unrelated debits or credits to your account.

Please complete the information below:

Training City: *  
Date/Time/Building: *  
First Name*
 
Last Name*
 
Organization
 
Address*
 
City*
 
State*
 
ZIP*
 
Phone 1 (Mobile)*
 
Phone 2 (Mobile)
 
Email*
 
Please provide your number of years experience in Green Infrastructure and/or Training:  

Education

Please provide your highest level of education.*





 

Training

Do you have an ADA Title I disability/impairment for which you may need assistance during the training?


Please send a letter to NGICP@WEF.ORG (from a medical professional authorized to make such assessments) that describes the specific accommodations that will be required.


Applicant Certification*
Yes  

I certify that all information contained in this application is true and correct to the best of my knowledge and belief. I understand that omissions may disqualify me and that knowingly making a false statement may result in the NGICP’s refusal to issue a training certificate or a revocation of any certification granted, as well as possible prosecution under appropriate law, which could provide for criminal penalties of a fine, imprisonment or both. I consent to an investigation of my education and training participation and other statements for the purpose of verification of my eligibility for certification. Additionally, I understand that if my application is randomly selected for audit, I may need to provide additional information or sign a release so that my information can be verified. I also understand that if I am successful and I am awarded the NGICP train-the-trainer certification, my name, city, state and certification status will be listed on the NGICP website and third-party individuals and organizations such as potential employers will be given specific verification of my certification status if it is requested.



Code of Conduct*
I agree to the Code of Conduct  

By agreeing to the Code of Conduct, I agree to adhere to the following Code of Conduct and understand that failure to do so may result in the loss of certification:

  • Act honestly, competently and with integrity;
  • Use my knowledge and skill for the protection of the water environment;
  • Be truthful and accurate in the information I provide to the NGICP;
  • Adhere to all laws and regulations applicable to the profession
  • Promote and encourage a high quality level of work on all green infrastructure projects;
  • Accurately represent my qualifications and credentials;
  • Protect and keep information, including exam content, confidential in order to maintain it as an accurate validation of others’ knowledge in green infrastructure;
  • Strive for continued professional development throughout my career in a way that supports on-going improvement and efficiency of my day-to-day job tasks;
  • Properly use the training certificate, stamp and other marks of the NGICP designation, which are the property of WEF, as I am specifically authorized to do so; and represent the NGICP professionally.

I further understand and agree that my signature constitutes a binding acceptance of these pledges and conditions.
I further understand that review within the NGICP Certification Council will be the final determination of any matter arising between NGICP and me.

Please type your FULL NAME and DATE if you agree to the code of conduct:
*  

Authorizes Water Environment Federation to charge the amount listed below.

The cost of this training is $1500. This gives you access to the course material and training curriculum.

PLEASE NOTE: In order to provide the training to your audience, a training license must be purchased from the Water Environment Federation. The cost of the training license is $7500 and due prior to any training offering by you. If you choose to become an NGICP partner, the cost of the workshop and the training license will be discounted from the NGICP Partnership Package costs in 2018. Please contact ngicp@wef.org if you are interested in acquiring a training license.



Amount*: $  
Account Type*:  
Cardholder Name*:  
Card Number*:  
Expiration Date*:  
CVV*:  
My above Address is my Billing Address
Billing Address*:   Phone*:  
City*:   State*:   ZIP*:  
Email*:  
I authorize the above named business to charge the credit card indicated in this authorization form according to the terms outlined above. This payment authorization is for the goods/services described above, for the amount indicated above only, and is valid for one time use only. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company; so long as the transaction corresponds to the terms indicated in this form. Receipt of payment will be sent to the listed email address, unless otherwise specified.
I certify that my answers are true and complete to the best of my knowledge.  
If you have questions regarding your payment, please contact:

Accounts Receivable

703.684.2427 - Phone
703.684.2428 - Fax
payments@wef.org