Certified Memorialist - Application Form

Applicant Information

Name:

Company:

Address:

Country:

Phone:

Fax:

Email:

Website:

Position:

Length of Time:

What year do you turn 65?

I have been in the memorial industry in a full-time capacity for:

Billing Information Same as Above

Name:

Company:

Address:

Country:

Phone:

Email:

PARTICIPATION ACTIVITY RECORD: You will also need to complete the "Participation Activity Form (below)". Include any necessary documentation to verify points claimed. The CM Application will not be processed without the "Participation Activity Form".

PREREQUISITES FOR CERTIFIED MEMORIALIST®

At least two years experience in a full time position in the memorial industry.
Currently employed in a full time position in the memorial industry.
Acceptable character, ability, and reputation.
Pledge in writing to adhere to the MBNA Code of Good Practice.
A minimum of 50 points earned through participation and activity in a broad range of fields recognized as indicative of professional interest and attainment in the memorial industry. These categories and the point system are specified on the “Participation Activity Form.” Individuals have a maximum of five years immediately preceding application for certification during which to accumulate the required points

Requirements to earn the “Certified Memorialist”® designation under the MBNA Certification Program are divided between successful completion of the examination, which is based upon material in the Certification Manual, and the accumulation of points awarded for participation in the specific activities listed below. To achieve initial certification, a minimum of 50 points must be accumulated; individuals have a maximum of 5 years immediately preceding application for certification during which to accumulate the required points.

INITIAL CERTIFICATION CM PARTICIPATION ACTIVITY FORM
Participation/Activity	Points Earned per Year	Maximum Points over 5 Years	Points Claimed
Membership (by firm) in MBNA	2	10
Membership in a recognized state, regional or provincial industry association	1	5
MBNA Officer/Trustee	4	20
Officer in recognized state, regional or provincial industry association	3	15
Director/Board Member in recognized state, regional or provincial industry association	2	10
MBNA Committee Chair	2	10
MBNA Committee Member	1	5
Minimum Points Required = 10 Maximum Points Allowed = 30 Total Points Claimed for this Section:
Attendance at MBNA & recognized industry education sessions: MBUniversity sponsored seminars/webinars Education sessions at MBNA Annual Convention and/or state, regional or provincial industry conventions Approximate guideline: 1 hour = 1 point; ½ hour = .5 point. Courses NOT offered through MBUniversity must be pre-approved by the Certification Committee.	n/a	35
Completion of an MBNA authorized design course	20	20
Completion of college level continuing education course, business related. Documentation of successful completion required.	5	10
Participation in Set-Up/Tear-Down Crew at MBNA Annual Convention. Guideline: Crew Member = 2 points per day; Crew Chief = 3 points per day	4	10
Attendance at an MBNA Annual Convention	1	5
Attendance at a recognized state, regional or provincial convention. May attend more than one a year. Documentation Required.	1	10
Program Speaker at an MBNA National Convention	5	25
Program Speaker at a state, regional or provincial industry conventions	2	10
Minimum Points Required = 10 Maximum Points Allowed = 25 Total Points Claimed for this Section:
Documented achievement (by firm) in public relations. Examples include: Aspire Award Winner News articles Open house Industry Speaker (presentations to schools or community organizations)	2	10
Documented community service. Examples Include: Cleanup of a local cemetery Re-setting old monuments Cleanup of local public monument Donation of service to design/construction/setting of a new public memorial	2	10
Contribution of a major article to a national industry publication. Copy of published article is required.	5	10
Other contributions to the industry not claimed above. Describe in detail & document. Contribution must be pre-approved by MBNA.	5	10
Minimum Points Required = 5 Maximum Points Allowed = 15 Total Points Claimed for this Section:
Minimum Points Required = 50 Maximum Points Allowed = 80 TOTAL POINTS CLAIMED FOR CERTIFICATION:

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Payment Information

Registration includes a digital version of the CM Manual, available when you log-in to the online exam portal.

Registration Type:

Members ($300) Non-Members ($800)

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I checked for errors and verify that all information entered is correct to the best of my knowledge.

I fully understand that it is an application for enrollment purposes only. In order to be processed, a fully executed Participation Activity Form must be submitted at the same time. I will submit to written examinations, be available for oral interviews if requested, and supply further information as determined by the MBNA Certification Committee. I further understand and by submitting this form I subscribe to the MBNA Code of Good Practice with the knowledge that any false statement or misrepresentation that I may make in the course of these proceedings may result in the revocation of this application and the issuance of a complaint of violation on said Code.