Certified Memorialist - Application Form

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Name:
Company: 
Street: 
City:   State/Prov:   Zip:  
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:
Where do you wish to take the CM Exam (check one)?
MBNA National Convention
At MBNA Headquarters in Dayton, Ohio (we will contact you to set up date and time)
State/Provincial Convention. Please specify:

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®

  1. At least two years experience in a full time position in the memorial industry.
  2. Currently employed in a full time position in the memorial industry.
  3. Acceptable character, ability, and reputation.
  4. Pledge in writing to adhere to the MBNA Code of Good Practice.
  5. 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
Payment Information: $250 USD Application Fee (Non-Members: $450 USD)
Credit Card Type: Visa   MasterCard   American Express
Credit Card Number:    Expiration Date:
Card Holders Name:

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
3 Years
Points
Claimed
Membership (by firm) in MBNA26
Membership in a recognized state, regional or provincial industry association13
MBNA Officer/Trustee412
Officer in recognized state, regional or provincial industry association39
Director/Board Member in recognized state, regional or provincial industry association26
MBNA Committee Chair26
MBNA Committee Member13
Minimum Points Required = 5            Maximum Points Allowed = 20            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.

All courses offered through sources outside MBUniversity must be pre-approved by the Certification Committee.
n/a25
Completion of an MBNA authorized design course2020
Completion of college level continuing education course, business related.
Documentation of successful completion required.
510
Attendance at an MBNA Annual Convention13
Attendance at a recognized state, regional or provincial convention. May attend more than one a year. Documentation Required.16
Program Speaker at an MBNA National Convention515
Program Speaker at a state, regional or provincial industry conventions210
Minimum Points Required = 5            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)
26
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
26
Contribution of a major article to a national industry publication.
Copy of published article is required.
510
Other contributions to the industry not claimed above.
Describe in detail & document. Contribution must be pre-approved by MBNA.
510
Minimum Points Required = 2            Maximum Points Allowed = 10            Total Points Claimed for this Section:
Minimum Points Required = 30            Maximum Points Allowed = 55            TOTAL POINTS CLAIMED FOR CERTIFICATION:

Upload any supporting documentation using the field below:

Please note: Zip compress multiple documents before uploading. Only .zip and .pdf files will be accepted. Please limit file size to 10MB or less.

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.