EPIC Diploma Exam Retake / Eligibility Extension Form Please complete this online form to register to retake the EPIC Diploma exam (Part 1 or Part 2) or to extend your eligibility to take the exam (Part 1 or Part 2) for another year--at a significantly reduced fee compared to the initial Exam Fee. Within fifteen business days after your payment is successfully processed, you will receive an updated Authorization to Test (ATT) Notice with instructions explaining how to schedule your exam appointment.Please note that the Exam Retake Fee and Exam Eligibility Extension Fee are non-refundable under any circumstances. If you have any questions before completing your purchase, please email epic@espnic-online.org or call +41 22 560 7401. One of our Credentialing Department team members will respond to your message within three business days. Next Question Title * Customer's Contact Information Surname / Family Name / Last Name * Given Name / First Name * Street Address, line 1 (mailing address of your current residence) * Street Address, line 2 City / Town * State / Province / Region Postal Code * Email Address, to which you consent that we will send all EPIC Diploma-related communications * Cellular Phone Number (include "+[countrycode]") * Next Question Title * Country in which you are currently working and residing ABW Aruba AFG Afghanistan AGO Angola AIA Anguilla ALA Åland Islands ALB Albania AND Andorra ARE United Arab Emirates ARG Argentina ARM Armenia ASM American Samoa ATA Antarctica ATF French Southern Territories ATG Antigua and Barbuda AUS Australia AUT Austria AZE Azerbaijan BDI Burundi BEL Belgium BEN Benin BES Bonaire, Sint Eustatius and Saba BFA Burkina Faso BGD Bangladesh BGR Bulgaria BHR Bahrain BHS Bahamas BIH Bosnia and Herzegovina BLM Saint Barthélemy BLR Belarus BLZ Belize BMU Bermuda BOL Bolivia (Plurinational State of) BRA Brazil BRB Barbados BRN Brunei Darussalam BTN Bhutan BVT Bouvet Island BWA Botswana CAF Central African Republic CAN Canada CCK Cocos (Keeling) Islands CHE Switzerland CHL Chile CHN China CIV Côte d'Ivoire CMR Cameroon COD Congo, Democratic Republic of the COG Congo COK Cook Islands COL Colombia COM Comoros CPV Cabo Verde CRI Costa Rica CUB Cuba CUW Curaçao CXR Christmas Island CYM Cayman Islands CYP Cyprus CZE Czechia DEU Germany DJI Djibouti DMA Dominica DNK Denmark DOM Dominican Republic DZA Algeria ECU Ecuador EGY Egypt ERI Eritrea ESH Western Sahara ESP Spain EST Estonia ETH Ethiopia FIN Finland FJI Fiji FLK Falkland Islands (Malvinas) FRA France FRO Faroe Islands FSM Micronesia (Federated States of) GAB Gabon GBR United Kingdom of Great Britain and Northern Ireland GEO Georgia GGY Guernsey GHA Ghana GIB Gibraltar GIN Guinea GLP Guadeloupe GMB Gambia GNB Guinea-Bissau GNQ Equatorial Guinea GRC Greece GRD Grenada GRL Greenland GTM Guatemala GUF French Guiana GUM Guam GUY Guyana HKG Hong Kong HMD Heard Island and McDonald Islands HND Honduras HRV Croatia HTI Haiti HUN Hungary IDN Indonesia IMN Isle of Man IND India IOT British Indian Ocean Territory IRL Ireland IRN Iran (Islamic Republic of) IRQ Iraq ISL Iceland ISR Israel ITA Italy JAM Jamaica JEY Jersey JOR Jordan JPN Japan KAZ Kazakhstan KEN Kenya KGZ Kyrgyzstan KHM Cambodia KIR Kiribati KNA Saint Kitts and Nevis KOR Korea, Republic of KWT Kuwait LAO Lao People's Democratic Republic LBN Lebanon LBR Liberia LBY Libya LCA Saint Lucia LIE Liechtenstein LKA Sri Lanka LSO Lesotho LTU Lithuania LUX Luxembourg LVA Latvia MAC Macao MAF Saint Martin (French part) MAR Morocco MCO Monaco MDA Moldova, Republic of MDG Madagascar MDV Maldives MEX Mexico MHL Marshall Islands MKD North Macedonia MLI Mali MLT Malta MMR Myanmar MNE Montenegro MNG Mongolia MNP Northern Mariana Islands MOZ Mozambique MRT Mauritania MSR Montserrat MTQ Martinique MUS Mauritius MWI Malawi MYS Malaysia MYT Mayotte NAM Namibia NCL New Caledonia NER Niger NFK Norfolk Island NGA Nigeria NIC Nicaragua NIU Niue NLD Netherlands NOR Norway NPL Nepal NRU Nauru NZL New Zealand OMN Oman PAK Pakistan PAN Panama PCN Pitcairn PER Peru PHL Philippines PLW Palau PNG Papua New Guinea POL Poland PRI Puerto Rico PRK Korea (Democratic People's Republic of) PRT Portugal PRY Paraguay PSE Palestine, State of PYF French Polynesia QAT Qatar REU Réunion ROU Romania RUS Russian Federation RWA Rwanda SAU Saudi Arabia SDN Sudan SEN Senegal SGP Singapore SGS South Georgia and the South Sandwich Islands SHN Saint Helena, Ascension and Tristan da Cunha SJM Svalbard and Jan Mayen SLB Solomon Islands SLE Sierra Leone SLV El Salvador SMR San Marino SOM Somalia SPM Saint Pierre and Miquelon SRB Serbia SSD South Sudan STP Sao Tome and Principe SUR Suriname SVK Slovakia SVN Slovenia SWE Sweden SWZ Eswatini SXM Sint Maarten (Dutch part) SYC Seychelles SYR Syrian Arab Republic TCA Turks and Caicos Islands TCD Chad TGO Togo THA Thailand TJK Tajikistan TKL Tokelau TKM Turkmenistan TLS Timor-Leste TON Tonga TTO Trinidad and Tobago TUN Tunisia TUR Turkey TUV Tuvalu TWN Taiwan, Province of China TZA Tanzania, United Republic of UGA Uganda UKR Ukraine UMI United States Minor Outlying Islands URY Uruguay USA United States of America UZB Uzbekistan VAT Holy See VCT Saint Vincent and the Grenadines VEN Venezuela (Bolivarian Republic of) VGB Virgin Islands (British) VIR Virgin Islands (U.S.) VNM Viet Nam VUT Vanuatu WLF Wallis and Futuna WSM Samoa YEM Yemen ZAF South Africa ZMB Zambia ZWE Zimbabwe Next The Part 1 Exam Retake Fee is EUR 444. The Part 2 Exam Retake Fee is EUR 439.The Parts 1 & 2 Exam Retake Fee is EUR 794.The Part 1 Exam Eligibility Extension Fee is EUR 444.The Part 2 Exam Eligibility Extension Fee is EUR 439.The Parts 1 & 2 Exam Eligibility Extension Fee is EUR 794.By submitting this order form, you are authorizing us to charge your credit card for the applicable fees as of the date you submit this form, based on your answer to the question on this form (whether you are purchasing the Exam Retake Fee or the Exam Eligibility Extension Fee, and whether you are purchasing Part 1 only, Part 2 only, or both Part 1 and Part 2).EPIC Diploma Exam Retake Fees and Exam Eligibility Extension Fees are nonrefundable under any circumstances. Customers are encouraged to ask us questions (via email to epic@espnic-online.org or telephone at +41 22 560 7401) before submitting this form if you are unsure whether you want to purchase an exam retake or exam eligibility extension. Next Question Title * Are you registering to retake the exam or extend your exam eligibility--and for Part 1 or Part 2, or both? I am registering to retake the Part 1 exam and authorize payment of the Part 1 Exam Retake Fee - €444 I am registering to retake the Part 2 exam and authorize payment of the Part 2 Exam Retake Fee - €439 I am registering to retake the Part 1 exam and Part 2 exam and authorize payment of the Parts 1 & 2 Exam Retake Fee - €794 I am registering to extend my eligibility to take the Part 1 exam and authorize payment of the Part 1 Exam Eligibility Extension Fee - €444 I am registering to extend my eligibility to take the Part 2 exam and authorize payment of the Part 2 Exam Eligibility Extension Fee - €439 I am registering to extend my eligibility to take the Part 1 exam and Part 2 exam and authorize payment of the Parts 1 & 2 Exam Eligibility Extension Fee - €794 You’ll enter payment info after the survey. Next Question Title * Please upload an image (scan or photo) of your currently valid (NOT expired and NOT restricted or revoked) medical license. If you have multiple currently valid medical licenses, please combine them in a PDF binder and upload one single file here. (PDF, PNG, JPG, JPEG, and GIF files up to 16MB are supported.) PDF, PNG, JPG, JPEG, GIF file types only. Choose File Choose File No file chosen Remove File Please upload an image (scan or photo) of your currently valid (NOT expired and NOT restricted or revoked) medical license. If you have multiple currently valid medical licenses, please combine them in a PDF binder and upload one single file here. (PDF, PNG, JPG, JPEG, and GIF files up to 16MB are supported.) Next That's it! Within 15 business days after you successful submit your payment on the next screen, we will send you a new Authorization to Test (ATT) Notice with exam scheduling instructions. Thank you for your continued interest in earning the EPIC Diploma. 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