Understanding the registration options:
The first 5 are new certifications (You currently do not have ICU certifications or expired USASF).
ICU Certified - Up levels is if you have a current certification and need to move up 1, 2 or 3 levels. (eg: Currently have a valid ICU Intermediate and need to get ICU Median, you would select ICU Certified up 1 level).
Re-certification: Is re-certifying any level.