* An asterisk designates a required field

Applicant Information

Company Information

*	Company
*	Address
*	City/ Province
*	State		Country
*	Zip/Postal Code
*	Phone No.
	Fax No.

Desired Certification Level
Technician  Master Technician/Master Combo Exam
Spanish Exam (available for Technician level only)
Provide the month and year you began working in the Auto Glass Industry: Month Year
 
Checklists

Please read the following checklist appropriate to your certification level, and check off each point as you understand it.

Certified Auto Glass Technician Level
(A)	I understand and can use a NAGS Catalog and NAGS Calculator.
(B)	I understand OSHA required employee safety regulations.
(C)	I can measure and/or trace a pattern for a custom cut laminated glass part.
(D)	I am competent in all types of auto glass replacement from windshields to backlites and gaskets to urethane.

Certified Auto Glass Master Level
(A)	I am experienced and knowledgeable in custom cutting and finishing of automotive laminated glass..
(B)	I am experienced and knowledgeable in intermediate level automotive electrical testing and troubleshooting procedures and equipment.
(C)	I am experienced and knowledgeable in OSHA required employer safety regulations.
(D)	I am experienced and knowledgeable in OEM sunroof repair and replacement techniques.
(E)	I am experienced and knowledgeable in advanced wind noise and water leak diagnosis and repair.
(F)	I am experienced and knowledgeable in current standards and regulations that apply to the autoglass industry.

Technician, Spanish, or Master Exam Fee
$169.95 for NGA Members  $269.95 for Non-Members

Technician/Master Combo Exam Fee
$299.95 for NGA Members $399.95 for Non-Members

If you would like to save money and purchase the reference manual now, please check here:
$29.95 for NGA Members* $84.90 for Non-Members*

*Special price when purchased with certification registration. Standard price: NGA Member $54.95; Non-Member $109.90.

Payment

NOTE:To complete online registration, credit card is the only form of payment accepted. After filling out the form, click on the submit button and your information will be submitted by way of secure web server.

To pay by check:(Made payable to NGA) Press Ctrl-P or File-Print to print out this page on your local printer and mail to NGA with payment. NGA, 8200 Greensboro Dr., Ste 302, McLean, VA 22102, USA. Note: No need to press the "Submit" button if mailing in the form. Form and check must be mailed together. Non-U.S. organizations must make payment with a credit card or a draft on a U.S. bank. This draft can be purchased at a bank in your area.

Subtotal:
Shipping:
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Type of Card Visa MC AMEX Card Number Expiration Date Name on the Card * In lieu of a signature, please fill in your birth month and day (year not needed).  January  February  March  April  May  June  July  August  September  October  November  December 01  02  03  04  05  06  07  08  09  10  11  12  13  14  15  16  17  18  19  20  21  22  23  24  25  26  27  28  29  30  31 Policy Statement     I hereby apply for the NGA Certfied Auto Glass Technician Program and understand that certification depends on successful completion of specified requirements. I further understand that the information for my certification records will be treated confidentially, that the information provided by me or accrued in the certification process also may be used for statistical purposes, for evaluation of the certification program, and for verification purposes by potential and current employers and insurance companies, in accordance with standard NGA policies and procedures. To the best of my knowledge, the information contained in this application is true, complete, correct, and is made in good faith. I understand that NGA reserves the right to verify any or all information on this application and that any incorrect or misleading information or other actions compromising the certification and examination process may constitute grounds for revocation of my certification or other disciplinary action.