Coaching Application

First Name*

Last Name*

Membership Serial Number*

This is the 8 digit number on your membership card in the lower left.

Email (this must also be the email you log into your USABMX account):*

example@example.com

Phone Number*

Please enter a valid phone number.

Date of Birth*

Date

Street Address*

Street Address Line 2

City*

State*

Postal Code*

Country*

Please read each statement and check the box to agree with each statement:*

I understand that I must be at least 18 years of age to become a USA BMX CoachI understand that I have to submit my background check to USA BMX every two years.I understand that I must submit a copy of my Adult and Pediatric CPR CertificationI understand that I must complete the Abuse Prevention Systems Sexual Abuse Awareness Training program.I understand that the annual fee for a coaching license is $60I understand that it is my responsibility to keep my USA BMX Coaching License current along with my background check, Sexual Abuse Awareness Training, and my CPR and First Aid Certifications.I understand that the primary purpose of this coaching program is to help develop and implement a consistent new rider program that will encourage them to return to the track more often.I understand that as a coach my actions will reflect on my local track and I will maintain a professional presence at the track at all time.I understand that I will not receive my coaching certification until I have completed the all of the program requirements including submitting a New Rider Program (Lessons / Clinics / League) is published on my track's schedule.

Name*

First NameLast Name

Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code