ACHI Certificate Request Form

Name as it should be displayed on the certificate:*
Please do not include any credentials after your name e.g. PhD, F(ACHI), CHS(ACHI), etc.
ACHI certificate title:*

Fellow of the ACHIAffiliate of the ACHIAssociate of the ACHICertified Histocompatibility SpecialistCertified Histocompatibility TechnologistCertified Histocompatibility Associate
Date exam was taken:*

MonthDayYear
Date