Background Check Registration

First Name: Last Name: Birth Date: / / Address: Address Line 2 City: State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Federated States of Micronesia Guam Marshall Islands Northern Mariana Islands Palau Puerto Rico U.S. Minor Outlying Islands Virgin Islands Armed Forces Americas Armed Forces Europe, the Middle East, an Armed Forces Pacific Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Territory Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory Zip Code: - Zip Suffix Email: Day Phone: Start year with ASPNM Emergency Contact Name Emergency Contact Phone Number How did you hear about ASPNM? Why would you like to be a part of the ASPNM? Have you ever taught Adaptive Sports of any kind? Have you ever taught Skiing and/or Snow Boarding? Taught Adaptive Ski/Snowboard prior to ASPNM? PSIA or AASI certification Summer Sports certifications, skills, and years experience? Summer Sports equipment owned? Other sport skills/experience? Non-sport Volunteer? Other skills (non-sport) Consent to listing in volunteer directory? What skills do you have that you would consider contributing to ASP?ie: adaptive positioning, artist, construction, cook, electrical, equipment repair, event planner, financial planner, fund raising, graphics design, IT, media, photographer, PR, sales, seamstress, teacher, videographer, writer, MD, nurse, EMT, Wilderness FirstResponder, Wilderness First Aid, PA, PT, OT, RT, Midwife, etc.. ASP offers a wide variety of ways to get involved, including sports instructors, committee participation, and more! For which ASP events would you be interested in volunteering? What ideas or suggestions do you have that would improve ASP? Do you feel that you receive sufficient orientation and training to carry out your assignments? Captcha Create a Login Name: Login Password: Retype Password: If you have a coupon, please enter code here (case-sensitive):