New Affiliate Application

New Affiliate Application
Primary Contact Name*

First NameLast Name
Primary Contact Email*
example@example.com
Primary Contact Cell*
Please enter a valid phone number.

Program Information
Affiliate Program Name*
Program Street Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Facility Phone Number*
Please enter a valid phone number.
Facility Type*
Is your program exclusively for your members or residents?

YesNo

Affiliate Owner
Affiliate Owner Name*

First NameLast Name
Affiliate Owner Email*
example@example.com
Affiliate Owner Cell*
Please enter a valid phone number.

Trainee Information
Trainee Name*

First NameLast Name
Trainee Email*
example@example.com
Trainee Cell*
Please enter a valid phone number.
Trainee Street Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Requested Training Date and Location*
Trainee Shirt Size*

Certification
At least one of these is required to complete either the Head Coach or Coach training.

By way of more formal education and athletic certifications, at least one of the below credentials is required for all Coaches and Head Coaches. These are not required for Assistant Coaches or Volunteers-

RSB abides by the National Commission for Certifying Agencies (NCCA), the accrediting body for fitness organizations. Below is a list of qualifying certifications, according to the rigor of the NCCA. Other certifications will be considered on a case-by-case basis. (Please list the specific certification course you completed).

*NOTE: We do not accept non-proctored certificates from ISSA & NASM*
- NASM
  - Certified Personal Trainer
- American College of Sports Medicine
  - Certified Personal Trainer
  - Certified Exercise Physiologist
  - Certified Clinicial Exercise Physiologist
- American Council on Exercise
  - Certified Personal Trainer
  - Certified Medical Exercise Specialist
  - Certified Health Coach
  - Certified Group Fitness Instructor
- National Council for Certified Personal Trainers
  - Certified Personal Trainer
  - Certified Group Exercise Instructor
- National Strength and Conditioning Association
  - Certified Personal Trainer
  - Certified Strength and Conditioning Specialist
- Hold and maintain licensure in the profession of Physical Therapy, Physician, Occupational Therapy or Athletic Training under the issuing authority of any State or Province;
- Hold a formal undergraduate degree from an accredited academic institution in fitness or health-related field. (i.e., Kinesiology, Physiology, or Exercise Science.
(Additional information on certifications we accept - CLICK HERE)
Certification/License Upload*

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Additional Trainee Information
Additional Trainee Name

First NameLast Name
Additional Trainee Email
example@example.com
Additional Trainee
Please enter a valid phone number.
Additional Trainee Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Requested Training Date and Location
Trainee Shirt Size
Additional Trainee Certification Upload

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Application Status
Application Approval*
- I understand that approval is at the discretion of RSB staff.
- I understand that, if approved, there is an annual fee of $1,000 due prior to training.
- I understand that, if approved, there will be an invoice of $899 per person for head coach training due prior to attending the training.
YESNO