American Academy of Micropigmentation

Your Personal Application for Board Certification Exam

Click here for application in Adobe Acrobat to print

The 2010 Board Exams of the American Academy of Micropigmentation are offered
at the following examination sites. The CMI (Instructor) Exam is given annually
at the Annual AAM Xpo and by special arrangement.

Contact Dr. Kristanne Matzek toll free at 800/441-2515 for requirements.

Arizona	Arizona	California	Florida	Hawaii/Nevada
Jackie Thompson 602/370-8818	Dyanna Yost Contact	Dr. Kristanne Matzek 800/441-2515 Fax 949-709-4751	BocaTa2 By Arrangement Joyce Cirasuola 352/529-0211 Fax 352/529-0212	Honolulu Linda H Dixon MD 808/263-3227 Fax 808/261-9070 email
New Jersey	New Jersey	Ohio	Texas, Houston	Texas, San Antonio
Beau Institute By arrangement Rosemarie Beauchemin Tel 888-763-2328	MiChe Permanent Cosmetics Training Ctr By arrangement Michael Katz Tel 201/368-0098	Ruth Bailey Dancy Tel 330/488-0774email	Lisa Fast Houston, Texas Cell 832/623-6714 email	Yasmin Sotelo MD 210/641-2011 email
International Examiners			Joelle Senden Brussels, Belgium www.joellesenden.com email	Yuko Chuma Tokyo, Japan email http://www.yc-group.net
International Examiners			Belgium	Japan

To Register ONLINE Complete Form Below
$290 includes exam and Board Review Book

Your Name
Doing Business as	Year Started
Previous DBA	Year started
Address
Address (cont)
City
State
ZIP/Postal Code
Country
Home Telephone
Office Telephone
Cellular Telehphone
Email Address
Website
Year Trained	Year Started Practice
***1 Year Mininum Required***
Have you been practicing for 1 year?	If less than 1, please specify
I comply with all City , State and County laws?
Name of Insurance Carrier?	Year first insured
My native language is	If other please specify
I teach the following systems	Disposable Autoclave
I am an active member of	AAM SPCP Other
I follow CDC and OSHA standards in my facility
Please estimate how many of each procedure, including touch-ups, you've done
Eyebrows
Eyeliner
Lipliner
Full Lipcolor
Camouflage
Cheek Blush
Eye Shadow
What method do you teach?	Manual Rotary Coil
Social Security number
Questions/Comments/Concerns
Confirm that you have the following credentials on file or available upon request: Training Certificates, Insurance Applications, Insurance Policy, Client Records, Licenses as Required, Industry Memberships, Proof of Occupancy, DBA or Corp Documents, TB Test and dates,

I hereby affirm that I meet all the requirements to become an Academy Certified Instructor and all the information submitted in this document is true and correct as of this day signed below. I agree to support the mission of the Academy and notify the AAM of any changes in my contact information. I understand that this information will be used to determine my status as a qualified Candidate for Certified Instructor Status. I have received a copy of the Instructors Program Packet and if approved, I agree to abide by the educational standards set forth by the AAM. I understand that if I have submitted any information, which is false or misleading, or I fail to meet the requirements of the AAM, it is cause to disqualify me and or expel me from the Academy.

Board Eligibility

Proof of one year of clinical practice. Please submit business license or equivalent.
Proof of training: Certificate from the training course or a letter from your preceptor if training was performed as an apprentice; Completed a minimum of a 60 hour micropigmentation training course that has been certified and approved by the American Academy of Micropigmentation. This training is not limited to but must include a standard core curriculum with hands on practical experience. Applicants must have Bloodborne Pathogen certificate of training.
Applicants must hold Associate Membership status in the AAM which reflects proof of their training and business license

After the candidate has passed the board exam he is conferred the title of Diplomate in the AAM. Then, the practitioner may wish to join the AAM as a full active member or FELLOW . The minimum standards for board eligibility are listed below. If there are any questions please call the AAM office at 800-441-2515

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The American Academy of Micropigmentation is a proud Member of the
National Organization for Competency Assurance