Request for Duplicate CHFP or FHFMA Certificate

Upon confirming the designation was earned and it is still valid, HFMA will begin processing of the duplicate certificate. The date of the designation on the certificate will be the date it was earned. Because three persons sign the certificate personally, processing of the certificate takes 60-90 days. The duplicate certificate will be mailed directly to the candidate.

Fields preceded by an asterisk (*) are required. Applications missing this information will not be processed.

Contact Information

Member ID Number:
Email:
Application Date:
*First Name:
Middle Initial:
*Last Name:

Home Address Information
*Address1:
Address2:
*City:
*State Province:
*Zip/Postal code:
Home Telephone:
Home Fax:

Certification Status Duplicate certificate for: ($25 each) CHFP - Accounting and Finance Specialty CHFP - Patient Financial Services Specialty CHFP - Financial Management of Physician Practices Specialty CHFP - Managed Care Specialty FHFMA
Charge Payment Information
Please add up costs above and enter the total here $
Charge My VISA MasterCard American Express Discover
Card Number Expiration Date Cardholder's Name> Cardholder's Signature *(Type in your name, which will be taken as your signature.)* * Signature (Type your name, which will be taken as your signature)

Thank You!

Check Payment Information

If you need a printed version of this application, print from this screen
and send personal or company check to:

HFMA
Attn: Accounting Department
Two Westbrook Corporate Center
Suite 700
Westchester, IL 60154

By fax with credit card info to: (708) 531-0665