ACBSP™ 2025 Annual Certification Maintenance Registration and Payment Form Notify DemographicsBusiness InformationCertificate InformationCanidate and Certificant AgreementFirst NameLast NameEmailConfirm EmailCell phoneWhat is your ethnicity / race?- Select -American Indian/Alaska nativeAsianBlackMixed ethnicityNative Hawaiian/Pacific IslanderWhiteOtherI decline to answerPlease provide your gender.- Select -EunuchFemaleIntersexMaleNon-BinaryNon-ConformingTransOtherI decline to answerWhat is your age?- Select -25 - 3435 - 4445 - 5455 - 6465 or olderOtherI decline to answerPreviousNextCompany / Business InformationCompany Email AddressBusiness Address Line 1Address Line 2CityStateZip CodeCountrySelect CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelauBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDemocratic Republic of the Congo (Kinshasa)DenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRepublic of the Congo (Brazzaville)ReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUnited States (US) Virgin IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabweBusiness Phone numberFaxWebsiteDo you want your business information listed on our online directory? Yes NoPreviousNextI hereby attest that I will comply with the requirements of the ACBSP™ Certification Maintenance & Continuing Education Policy (see policy at https://acbsp.com/certification/certification-maintenance) These requirements include payment of the annual certification maintenance fee ($135 if paid Nov - Jan 31 OR $160 if paid Feb - Jun 30) & the requirements listed in the following attestations (CPR certification, misconduct in sport training & annual CEU requirements). Yes NoI hereby attest that I currently have a healthcare provider level CPR certification in good standing OR will by December 31, 2025. You have until December 31st to complete this continuing education requirement. Yes NoI hereby attest that I currently have a "misconduct in sport" training certificate in good standing OR will have by December 31, 2025. The ACBSP requires certificants to demonstrate evidence of training to recognize, reduce and respond to all misconduct in sport (i.e. SafeSport or comparable program) as a one-time requirement to maintain certification." You have until December 31st to complete this continuing education requirement. **Policy change February 2024: “The ACBSP™ shall require certificants to demonstrate evidence of training to recognize, reduce, and respond to all misconduct in sport (i.e., SafeSport or comparable program) as a one-time requirement to maintain certification** Yes NoI hereby attest that I have completed the required number of annual CEUs (12 for CCSP® OR 24 for DACBSP®) for the current year OR will by December 31, 2025. The ACBSP requirement is on an annual basis from January 1 - December 31. You have until December 31st to complete this continuing education requirement. Yes NoI hereby attest that the personal email address I have provided on this registration form is a unique email address and not shared by any other ACBSP certificant. I understand that this email address will be used by the ACBSP to communicate important information regarding my certification to me. I also understand that this email address will be used to allow me access to vote in the annual board election assuming I maintain my certification and remain eligible to vote. If I make changes to my email address, it is my responsibility to notify the ACBSP National Office. Yes NoPreviousNextPayment Item 2025 Certification Maintenance Fee + Reactivation Fee(CCSP® & DACBSP®) Retired/Non-practicing - Disabled - Military Certification Maintenance Fee + Reactivation FeePromo CodeApply CouponNo payment items has been selected yetPay with Card (Stripe) Previous Submit Form
