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:
City:
Zip Code: (5 digits)
State:
Phone Number:
Fax Number:
Email:
Which certificate did you lose?
When did you take the course?
How would you like to receive
your replacement certificate?
 
Mail    Email    Fax
Comments:
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.