To obtain a certificate, please complete the form and submit payment. There is a $25 processing fee for replacement certificates. For questions related to this policy or completing the form, please contact AKH at [email protected]. Please fill out the form in its entirety and click SUBMIT to complete payment. Thank you! Name * Title of activity: * Date of activity * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20212022202320242025202620272028 Are you claiming maximum or partial credit? * Maximum Partial Email * By checking here I agree to pay the total amount listed above. * Yes Leave this field blank
