*An asterisk designates a required field

Applicant Information

*	First Name		*	Last Name
*	Social Security #	(last four digits only)		Member #
*	Address
*	City/ Province
*	State			Country
*	Zip/Postal Code
	Email

Company Information

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

Desired Certification Level
Glass Installer (CGI)

Provide the month and year you began working in the Glazing Industry:  Month Year

Certified Glass Installer Checklist

Plastics
(A)	Types
(B)	Cutters and cutting tools, techniques
(C)	Fabrication tools, machining and procedures

Metals
(A)	Types
(B)	Cutters and cutting tools, techniques
(C)	Fabrication tools, machining and procedures
(D)	Finishes
(E)	Joinery
(F)	Doors and hardware

Sealants
(A)	Types
(B)	Applications, tools and machining procedures

Safety
(A)	Personal protective equipment (PPE)
(B)	OSHA regulations
(C)	Safety glazing and fire codes
(D)	First aid
(E)	Americans with Disabilities Act (ADA)
(F)	Scaffolding, rigging, ladders

Trade Math
(A)	Basic calculations
(B)	Measurement tools and techniques

Glass Installer Online Exam Fee (check only if you wish to take the exam via the Internet)
$129.00 for NGA Members $229.00 for Non-Members

Glass Installer On Site Exam Fee
$169.95 for NGA Members $269.95 for Non-Members

If you would like to save money and purchase the reference manual now, please check here:
$29.00 for NGA Members* $84.00 for Non-Members*

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

> Special price of $99.00 for MyGlassClass.com subscribers only!!!
Please contact Miguel Rodriguez at 703/442-4890 ext. 130 for more information!

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. 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:
Total:

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 Certified Glass Installer 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, but 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.