Name Change Request Form

Name Change Request

Have you changed your name after being certified? No worries, fill out the name change form online below and be prepared to download a copy of your legal name change document such as a driver's license, etc.
New Certificates are available with the new name change for a small fee.

Name Change Request Form

* Indicates required field

Today's Date *

Name on original certification *

I hereby request a change of name for my ABCM certification. *

Change my name on my certificate

New Name to be used hereafter. *

Submit proof of legal change of your name. *

Max file size: 20MB

Email *

Phone Number - private *

By typing my name in this box, I am providing my electronic signature and approve these changes. *

Submit