Lost Certificate

Lost Certificate

Please complete and submit the following form if you have lost your certificate, and would like a replacement sent to you.

First Name:
Last Name:
Address Street 1:
Address Street 2:
Zip Code: (5 digits)
Phone Number:
Fax Number:
Which certificate did you lose?
When did you take the course?
How would you like to receive
your replacement certificate?
Mail    Email    Fax
Enter code to the right, then submit *  

Please mail $5 to:

Empowering People
12402 N. Division #291

Spokane, WA 99218

Once funds are received, certificate will be sent.