ASM Instructor Application – USA

New ASM instructor Application - USA

The first step to becoming an ASM instructor is to submit an application with supporting documents. You will be able to save and continue if you need to come back to the form to complete it. The supporting documents you need are, a digital photo of yourself for your web listing, a one-paragraph bio for your website listing (introduction), a copy of your certifications and licensure.

Date(Required)

Are you applying for Lead (Level One) or Assistant (Level Two) instructor? Choose from dropdown(Required)

A Level One instructor needs to have EMT or higher education or equivalent medical training. If you do not have this level of training, Choose Level Two. There is no restriction in what a level two can teach, they simply can not teach without a Lead instructor present for the duration of the class.

Name(Required)

First Last

Title

Example: Paramedic, EMT, RN, MD.....

Nickname

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Cell Phone(Required)

Alternate Phone

Please indicate work, home, partner's cell...

Email(Required)

Enter your T-shirt size(Required)

Standard Unisex Navy Blue T-shirt with "Instructor" on the front left chest area and "A Crash Course for the Motorcyclist" on the back

Choose Short or long sleeves(Required)

Short Sleeves

Long Sleeves

S - 3X

Instructor Bio - in word doc format

Accepted file types: doc, docx, Max. file size: 112 MB.

One paragraph introduction to be placed on the website. Something about your motorcycling and medical background. For examples, see https://roadguardians.org/instructor-bios/. If unable to provide a DOC format bio please send in an email.

Instructor Picture for website

Max. file size: 112 MB.

Picture of yourself with your bike is preferred.

Picture, PDF, or scan of your Certs

Max. file size: 112 MB.

Professional license. Other certs are optional.

Conflict of interest form below:

Sign in to your account on the website to be able to access this form. Your user name is likely to be either your email or first initial and last name Reset your password if you do not remember your password.