CERTIFIED ELECTRONIC MEDICAL BILLER
CERTIFICATION APPLICATION
Please send all materials pertaining to the course of
study for Certified Electronic Medical Biller (CEMB).
I understand that this designation may be granted by the Electronic Medical Billing
Network of America following satisfactory completion and submission of three units of
homework and by passing the final examination with a grade point of 70 or higher. Enclosed
is the course fee of $875.00 plus $24.95 Priorty Mail Shipping and Handling. Please allow 10
days. Rush shipping available, please call.”
***********All prices are subject to change without notice**************
Please note: CEMB applicants should not send in the Membership Applicantion in addition
to this form since CEMB students automatically receive a one-year membership in the
Electronic Medical Billing Network of America and are afforded all benefits of the
national membership.
Applicant Name
Company
Address
City State Zip
E-mail Address
Telephone Number and Area Code
Please indicate the date, cost and purchase type of any discounts for prior purchases:
Date
Cost
Materials
Check here___include the informative handbook
“Medical Billing Secrets,” 88 professional billing tips. Only $10 additional
with original certification application (save $19).
NOTE: Print this page, cut out this section where
indicated and send with check payable to EMBN to:
Electronic Medical Billing Network of
America, Inc.
51 Eton Court, Bedminster, New Jersey 07921
Phone 908-470-4100 FAX 908-470-4233
Email: merl@medicalbillingnetwork.com
Major charge cards accepted
For faster service, use your
credit card. Fill out the additional information below,
print this page and fax to: 908-470-4233
American Express Master
Card Visa
Card Number
Date of
Expiration
Name on Card
NOTE: Print this page and mail with check or fax with
above credit card info to:
Electronic Medical Billing Network of America, Inc.
51 Eton Court, Bedminster, New Jersey 07921
Phone 908-470-4100 FAX 908-470-4233
Email: merl@medicalbillingnetwork.com