Coaches Membership Registration Form - Sept. 1, 2007 – June 30, 2007 Print This, Fill it out and Mail To: USFIFS, P.O. Box 1970, Bolingbrook, IL 60440 Phone: (708) 707-0992 Fax: (630) 378-9928 Email: info@usfifs.org
The info on this sheet is voluntary. You must also join USFIFS and fill out the Regular Membership Form to be listed as a USFIFS coach.Attach this to your membership form or send when you become a coach or change Info—There is no additional charge for a coaching registration or update. Only information you want posted will be on the web. Check the boxes at the bottom.You must be 18+ yrs. to post this info. Name ______________________________________________USFIFS # _____________________ (Use the Name that you would want to appear on the website)(Leave blank if new or unknown) Where do you teach ? ___________________________________________________________________________________________ What skills do you teach? _________________________________________________________________________________ Coaching Memberships and Certifications: _________________________________________________________________________________ Do you have coaches liability insurance or bond? If so, who is the organization or company that provides it? _________________________________________________________________________________ Do you have CPR/First Aid Training only (Y/N)or Certification (Y/N)(Circle one) Have you been or are you a skating officer, official, judge and current/past positions held in skating organizations (Include any judges certifications and levels.. Attach an additional sheet if needed) _____________________________________________________________________________________________________________________________________________________________ Check which ofthe following information you would like posted on the Internet. Space may be limited for additional info. (Due to legal concerns only information about coaches 18 years and older can be posted): ___ Name___ Email ___Coaching Certifications___ Skating Levels and Tests Passed ___ Address___Skating Officer Experience___ Liability Insurance or Bond Coverage ___ Phone___Coaching Memberships___Other (write here,on back,or another sheet) __ I would like to be considered for the following: Member of Board of Directors,Officer of Board of Directors, Committee Chair, Committee Member or other positions.(Feel free to attach additional sheets or send an email ): ____________________________________________________________________________________________ The above information is true and accurate to the best of my knowledge. I understand that the USFIFS reserves the right to edit and reject content for any reason. I also understand that USFIFS in not responsible for the accuracy of the information posted, but will make an attempt to correct any incorrect information after notification as soon as reasonably possible . USFIFS may reject any changes if they are not consistent with the goals of the organizations and will remove any listings upon request or if it isinappropriate as soon as reasonably possible Your Signature ___________________________________________________________________ Date: ___________________________________________________ (This form must be signed in order to post your information) - 8/20/07
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