US SAILING Level 1 Windsurfing Instructor Application
LOCATION OF COURSE __________________ DATE OF COURSE ______ APPLICANT ____________________________ DATE __________________ PERMANENT ADDRESS: No._______ Street/P.O. Box____________________________________ City____________________ State_____________ Zip__________________ PHONE EMAIL ______________________ DATE OF BIRTH___________ SEX ____ CURRENT OCCUPATION: _______________________________________________ Job Position/Student Do you have any learning or physical disability that would prevent you from fully participating in this course? _________________________________________________________ IN CASE OF AN EMERGENCY: Name ________________________________ Relationship _____________________ Phone Number___________________ US SAILING MEMBER NO.__________________ USWA MEMBER: Yes____ No____ ************************************************************************ CURRENT WINDSURFING EMPLOYER NAME _________________________________________________________ POSITION ________________________________________ ADDRESS: No._______ Street/P.O. Box____________________________________ City____________________ State____________ Zip________________ PHONE __________________ NAME OF SUPERVISOR_________________________ WINDSURFING/SAILING CERTIFICATIONS (IF ANY) __________________________________________________________ BOARD(S) YOU WILL BE USING __________________________________________________________ ****************************************************************** COURSE MATERIALS We must receive this completed application and course fee payment at least 2 weeks prior to the course or a late fee of $50 will be charged in addition to the course fee. Note: If your mailing address is different from address above, please indicate here: Familiarization with the course materials is essential as there are approximately 400 pages of text so plan on studying prior to and each night of the course. ****************************************************************** NOTE-REGISTRATION FOR ALL US SAILING TRAINING COURSES ARE ON A FIRST COME, FIRST PAY BASIS! EMPLOYMENT (WINDSURFING) HISTORY
SAILING EXPERIENCE List the boards/boats that you have sailed and know well __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ RACING EXPERIENCE Yes____ No____ List the Major Regattas you have attended, including class: __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ Check below if next season you would like to be included (free) in a mailing to instructional sailing programs seeking US SAILING certified sailing instructors. _____ BRIEF ESSAY: On a separate sheet and in 200 words, outline why you want to be an instructor, and what you hope to learn from this Windsurfing Course. Please attach to this application form. SAFETY: 2. Date of American Red Cross, American Heart Association, or Green Cross CPR Certification. ______________________ 3. Date of American Red Cross or Green Cross Standard First Aid Certification ________ Both CPR and First Aid must be current and produced at course! ****************************************************************** Training Fee for Level 1 Windsurfing Instructor Course:
$275 Charge: Visa____ MasterCard____ American Express____ Check/Money Order _____ payable to US SAILING Enclosed Card No. _________________________________Expiration Date:___________________ Signature ____________________________________ NOTE: Payment must be received at least 2 weeks prior to the beginning of the course or a late fee of $50 will be charged in addition to the course fee. The Training Fee covers publications, registration materials, processing and Instructor Trainer costs. THE TRAINING FEE IS NOT REFUNDABLE. Return this form to US SAILING, Box 1260, Portsmouth, RI 02871. Signature_______________________________________
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