Other Exam Voucher RegistrationAfter completing this form, an email will be sent to your email address that will serve as your voucher for taking the test. Please be sure to print out the test voucher email and bring it with you to the testing location, along with a government issued ID.Certification*Select Certification TypeGroup ExerciseMedical FitnessSenior FitnessYouth FitnessExam LocationIndicate the scheduled location where you plan to take the exam? Select the State, City, Date and Exam Type below. (See link below for scheduled location options.)Refer to the W.I.T.S.other exam location and date scheduleand then select the appropriate location and date in the drop down menu below. Dates and or times subject to change due to weather, site availability, etc. Call 888-330-9487 with any questions. Student must sign up to test in the school of record or get special approval from the testing department to go to another testing site. NOTE: All registrations must be received by W.I.T.S. a minimum of 35 days prior to the requested test date. Exam Location, Date, and Type*Select a Location, Date & Exam Type00 Online - 12/14/2021 - MFSCT Bridgeport - 12/4/2021 - CPT HybridCT Enfield - 12/4/2021 - CPT HybridCT Waterbury - 12/4/2021 - CPT HybridFL Fort Myers - 12/4/2021 - CPT HybridFL Sarasota - 12/4/2021 - CPT HybridGA Savannah - 12/4/2021 - CPT HybridIL Dixon - 12/4/2021 - CPT GoldIL Glen Ellyn - 12/4/2021 - GFIMA Danvers - 12/4/2021 - CPT HybridMI Ann Arbor - 12/4/2021 - CPT HybridNJ West Windsor - 12/4/2021 - CPT HybridNY Kingston - 12/5/2021 - CPT HybridNY Staten Island - 12/4/2021 - CPT HybridPA Philadelphia - 12/4/2021 - CPTSC Charleston - 12/4/2021 - CPTTX El Paso - 12/4/2021 - CPT HybridTX Jacksboro - 12/4/2021 - CPT HybridTX McAllen - 12/4/2021 - CPTTX San Antonio - 12/4/2021 - CPT HybridVA Richmond - 12/4/2021 & 12/5/2021 - CPT GoldVA Virginia Beach - 11/30/2021 & 12/2/2021 - CPT HybridExam TypeCHECK THE BEST BOX THAT APPLIES.Incomplete Exam (past student in a preparatory college class)Gold Exam (exclusive online preparatory student ready to test)Current Student (recently completed an optional college preparatory course & is ready to test)Location Change Acknowledgment*I understand that location sites, as well as exam dates, are subject to change due to COVID issues, the availability of the location(s), etc. In such cases, the next closest location will be made available. Yes, I understand.Code of Ethics*I have read and agree to adhere to the W.I.T.S. code of ethics.Yes, I agree.Test Confidentiality*I agree to keep any and all test information confidential about the certification exam. I will not disclose any information about the exam or cheat in any way during the exam.Yes, I agree.Test RequirementsAge Requirement*I am at least 18 years of ageCPR/AED Certification*After submitting this form you are required to email proof of your CPR/AED certification. (Live required. Online version not accepted.) It is preferred you submit a copy of your CPR/AED prior to your scheduled testing date to avoid any delays in the issuance of the Certification. If you are unable to obtain/ provide a copy prior the testing date you will still be eligible to test, but will be required to send proof within 60 days of the original testing date in order to have a Certification issued. Failure to supply a valid CPR/AED within that time from will result in a non-issuance of your certification. You will receive a confirmation email after submitting this form. Reply to the confirmation email and attach your proof of CPR/AED certification. Accepted file formats: pdf, zip, jpg, gif, png, docx, doc, xlsx, xlsThe certification council requires that the W.I.T.S. office must receive the proof of the CPR/AED.Your registration is not complete until you have emailed us proof of your CPR/AED certification.I will send proof of CPR/AED Certification (Live required. Online version not accepted.)I am taking the CPR/AED course soon. I will send the certification card or confirmation letter as proof within 60 days of the original testing date in order to have a certification issued.High School Diploma/GED*I have earned my High School Diploma or GED equivalentHigh School Diploma / GED Details*For Diploma: Enter the name, city and state of high school, and date of graduation. (ex. Central High School, Virginia Beach, VA, 2014)For GED: Enter GED, state and date you earned your GED. (ex. GED VA 2014) English Comprehension*I have English comprehension for the written and practical examsCOVID-19 Notice*We care about our student trainers, teachers and testers. Therefore, we are requiring masks to enter the gym or college location at the assigned time/s.I understand that due to the COVID-19 pandemic that there is a risk. I agree to wear a mask at all times and that I will be asked to leave the facility if I do not have one or wear it on site at all times.Cancellation Policy*I confirm that all cancellations need to occur a full 72 hours prior to the scheduled exams in order to receive a refund of my testing fees.Yes, I confirm.ADA accommodations needed?*YesNoALERT: Send all ADA official document forms to firstname.lastname@example.org at least 30 days in advance of the exam or your testing may be delayed, as adequate time is required to verify and arrange your special accommodations with the hosting college. Delays in receiving the ADA forms for verification can delay your test being delivered on time.Student InformationName*FirstLastEmail*Phone*Country*United StatesOther (Canada, Jamaica, etc.)Address*Street AddressAddress Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificStateZIP CodeInternational Address*Street AddressAddress Line 2CityState / Province / RegionZIP / Postal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryDate of Birth*Date Format: MM slash DD slash YYYYGenderSelect GenderMaleFemalePrefer not to answerCommentsThis field is for validation purposes and should be left unchanged.