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ABRET Executive Office
Special Testing Request
Please read the directions in the
Handbook for Candidates
carefully before completing this application.
Name (exactly as it appears on a Government Issued Photo I.D.):
*
Street Address/PO Box
*
Address Line 2
City
*
State/Province/Region
*
Zip/Postal Code
Phone Number
*
Date of Birth (mm/dd/yyyy)
*
Gender
*
Male
Female
Country
*
Email Address
*
Exam
Selection
Select Exam
EEG
Select Exam
CLTM
Select Exam
EP
Select Exam
CNIM
Select Exam
Payment
A fee of $225.00 is
required
to submit the Special Testing Request Form.
*
Special Testing Fee ($225.00)
*Click Continue to complete payment.
ABRET/ABCN | 111 E. University Dr. #105-355 | Denton, TX 76209 | ph/fax 217.726.7980