Recertification Application

Personal Information

Name*

RST #*

RST Date Earned*

Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Cell or Home Telephone

Work Telephone

Email Address*

Eligibility Status

I am currently certified in Basic Life Support for Healthcare Providers
(All candidates must be certified - attach a copy of an unexpired card)
I have uploaded certificates showing at least 50 sleep-related continuing education credits earned in the past five years to the ABSM credit-tracking site http://my.absm.org/registrationselect.aspx
I intend to take the RST recertification examination prior to my certification expiring. Please send me instructions for registering for the exam.

Basic Life Support Card*

Attestation

*

By typing your full name below, you hereby declare the following: That all information contained in this application and all documentation submitted with or in support of the application is true. I understand that the ABSM conducts random audits as part of the recredentialing process. I understand and agree that any misrepresentation of said facts will result in revocation of the credential obtained.

Fee Schedule

Recertification Fee*

Recertification Fee ($50.00)
RST Exam ($175.00)

Extension

One-time 90-Day Extension Fee ($50.00)

Total

$0.00

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

RST Recertification Application

Personal Information

Eligibility Status

Attestation

Fee Schedule