(More information available at www.macsw.org) To request Section 609 home study certification tests, please fill out the following information & return to MACS Worldwide with payment. You may mail, fax or email this form but it must be accompanied by $20 for each test requested. Do not use this form if you want an online test. (More information available at www.macsw.org) $20 per test 1st Tech:_____________________________________________Email address: ______________________________ ❒ $20 per Certification Test 2nd Tech_____________________________________________Email address: ______________________________ ❒ $20 per Certification Test 3rd Tech:_____________________________________________Email address: ______________________________ ❒ $20 per Certification Test 4th Tech:_____________________________________________Email address: ______________________________ ❒ $20 per Certification Test 5th Tech:_____________________________________________Email address: ______________________________ ❒ $20 per Certification Test 6th Tech:_____________________________________________Email address: ______________________________ ❒ $20 per Certification Test 7th Tech:_____________________________________________Email address: ______________________________ ❒ $20 per Certification Test 8th Tech:_____________________________________________Email address: ______________________________ ❒ $20 per Certification Test 9th Tech:_____________________________________________Email address: ______________________________ ❒ $20 per Certification Test 10th Tech:____________________________________________Email address: ______________________________ ❒ $20 per Certification Test (Attach list if necessary) Shop / Company Name ___________________________________________________________________________________________________ Shop Manager Name ______________________________________________Email address:__________________________________________ Mailing address: ________________________________________________City/State/Zip: ____________________________________________ Area Code/Phone: ________________________________________________Fax: ___________________________________________________ MACS Worldwide P.O. Box 88 Lansdale, PA 19446 Phone: 215/631-7020 * Fax: 215/631-7017 * email: info@macsw.org ❒ Check/MO# ________ for $ __________ Charge my: ❒ Mastercard ❒ Visa ❒ AMEX ❒ Discover Card# ___________________________________________________Name On Card ___________________________Ex. Date _________ CVV2/Sec Code __________________(3 or 4 digit # on front or back of card) ________________http://www.macsw.org http://www.macsw.org