If you are mailing or faxing this
application and if postmarked with check or faxed with
credit card by January 31, following your
credential expiration date, the fee is $55
USD. If sent AFTER January 31, following
your credential expiration date the fee is
$80 USD (which includes the late charge).
Mail your completed form and fee to ABMCN,
4435 Waterfront Drive, Ste. 101, Glen Allen,
Virginia 23060, (804) 527-1905. If paying by
credit card, you may fax (804) 747-5316 or
mail your form. If you send your form by
fax, DO NOT MAIL the original as this may
result in second charge to your credit card.
The fee covers review of CE activities
submitted for this cycle and services
provided to ABMCN during the three-year
cycle just completed and is not refundable.
ABMCN Tax ID # 54-1905803
I hereby verify the truth of the
entries on this Summary of Continuing
Education Activities Form. I affirm that I
participated in the activities listed and
that the number of CE hours represented the
actual number of education hours I
completed. If the provider obtained prior
approval of the activity for CMCN CE, the
number of hours listed is the same as that
pre –approved by ABMCN.