Active Assailant Certificate of Qualification

Please confirm your email address and the last 4 digits of your ssn (USA only) or Four-digit of your birth date (DDMM for Non-USA) and the course number you attended. Our system cannot find your information.

Are you a member?

Yes

How you would like your full name to appear on your certificate?

Agency Name:(If applicable)

E-mail:

Course ID:

First Name:

Address:

City:

Postal Code:

Agency Contact Name:(If applicable)

USA: Last four digits of SSN | Non-USA: Four-digit birth date (DDMM)

Phone Number:

Last Name:

State/Province:

Country:

Country is required.

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