American Sport Education Program
Training Center Application (All fields are required)

1) Training Center (TC) Information *:
Training Center Name:   
Address1:
Address2:
            City:    Province/State:    Zip:
Country:    
      Phone:    Fax:
 
 
Training Center Shipping Address (if different):
Address1:
Address2:
            City:    Province/State:    Zip:
Country:    
      Phone:    Fax:
 
2) Business Structure*: Do you offer classes to the public for a fee?
Yes(Entrepreneurial)
No Corporate   Government/Non-Profit   Healthcare/EMS   Educational Institution  
Are you an existing Human Kinetics Emergency Care Training Center? Yes  No
Are you an existing ASHI Training Center? Yes  No
 
3) Who is your Intended Audience(s) for CPR/AED for Coaches Course?*:
Scholastic Coaches (Grades 5-12)
Youth Sport Coaches (Up to Age 14)
Competitive Club Sport Coaches
College/University Sport Coaches
General Public
Other
4) Training Center Director *:The Director is the business owner, executive officer, or other responsible individual associated with the organization who will manage this training center. Only a person authorized to oblige the organization to the terms of this agreement should sign this application.
First Name:   Last Name:
         Email:
Address1:
Address2:
            City:    Province/State:    Zip:
Country:    
      Phone:    Fax:
 
5) Training Center Point of Contact *: The Point of Contact is the business owner, an executive officer, or other responsible individual associated with the organization who will implement the CPR/AED for Coaches initiatives and manage administrative responsibilities. This person can also be the Training Center Director.
Training Center Director is also the Point of Contact. Use the same information from above.
First Name:   Last Name:
         Email:
Address1:
    Address2:
            City:    Province/State:     Zip:
Country:    
          Phone:     Fax:
 
6) Training Center Agreement *:
I understand and agree for myself and all other persons acting on my behalf or on behalf of my Training Center that approval, as an ASEP Training Center is a privilege, not a right, and may be revoked. My Training Center will provide programs and operate in accordance with the most recent version of the Training Center Administrative Manual that will be provided as part of the training center and instructor development process.
If you agree with these statements, click here.

Please complete all questions before submitting your application, as you will be unable to return to the form later. We will contact you during the application review process if further information is needed.