D FELDWIES WIRTSHAUS AG

FOR INTERNAL USE
 Approved for Renewal
FOOD DEFENSE COORDINATOR RECERTIFICATION
Proof of Attendance
Note: A minimum of two hours of training must be obtained to fulfill the recertification requirement.
Name:
(Last)
(First)
(MI)
Company:
Address:
(City)
(State/Province)
Phone:
(Zip/Postal Code)
(Country)
Fax:
Email:
AIB Certified Food Defense Coordinator Number (see wallet card):
Certification Expiration Date:
Name of Course or Conference Attended:
Location of Event:
Date(s) of Event:
Topic(s) Covered
Length of Time
Presenter’s Name
Provide a summary of what you learned and explain how you will be able to apply this knowledge
in your current Food Defense Coordinator position.
Proof of attendance (certificate of completion, receipt of registration and attendance, agenda, etc.)
for any non-AIB course or conference attended must be provided.
Submit this form and the supporting documents via email, fax, or mail for review. Upon receipt and review,
you will receive an email notifying if approved along with instructions for payment of the recertification fee.
DO NOT SEND PAYMENT WITH THIS FORM.
AIB International
Attn: Customer Service
PO Box 3999
Manhattan, KS 66505-3999
tel: 800-633-5137 or 785-537-4750
fax: 785-537-1493
email: [email protected]

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