Name_______________________________ Region____________ Country_______ NMRA No.__________

Street______________________________ City___________________ State______ Zip Code_____________

 
___________________________________________________________________________________________ 
 Description of models built: 
 
 
 
 
 
 
 
 
Please attach to this SOQ all the documentation required by the AP Regulations.  
This includes; the trackplan required in Section 1, and a description of the features required in Section 2. 
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Witness Affidavit:
I certify that I have judged the work of the member requesting certification.

SIGNATURE ____________________ NAME________________________ NMRA No ______________

TITLE_________________________________________________________ DATE _________________

SIGNATURE ____________________ NAME________________________ NMRA No ______________

TITLE_________________________________________________________ DATE _________________

Members Statement and Agreement:

I certify that I have completed all of the requirements for this subject matter as listed in the official NMRA Achievement Program Regulations and that I will agree to assist other members in the subject matter of this certificate whenever possible, whether or not they are participants in the Achievement Program.

SIGNATURE ______________________________ Date__________

Certification of Regional Achievement Program Manager:

As the NMRA Regional Achievement Program Manager of the __________________ Region, I certify that I have examined this statement of qualifications and, having compared it to the stated requirements for this certificate, I am satisfied that the stated requirements have been met.

SIGNATURE ______________________________ Date__________ Region/Cert #_________________

National Vice Manager Action:

Approved _________________________________ Date__________

All AP forms are available from your Regional AP Manager.