Application Form | International Rescue Instructors Alliance

Application Form
Becoming a member

1. Fill in the registration form below.

2. Pay membership fees online. Once your registration has been sent, you will be directed to the membership fees page where you can choose either Associate or Professional Membership. You can pay for your membership fees using either PayPal or a credit card (via PayPal)

3. The Executive will then contact you once your payment and registration (if applicable) have been received.
Personal Information
Title
Last Name *
First Name *
Second Name
Email (Primary) *
Email (Alternate)
Address *
Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone (Cell)
Phone (Work)
Phone (Residence)
Occupation
Current Primary Safety/Rescue Affiliation/Employer
Occupation Details
What Occupational Group do you primarily operate in? (check as applicable)
Emergency Response Emergency Response (armed) Industrial Safety Natural Resource Management Professional Guiding Personal / Public Safety Outdoor Recreation
What responsibility do you have?
Operations Operations Management Instructing Training Management Risk Management Health and Safety Legal Financial Marketing Research Program Development Other
Organization Type
Government NGO Publically Traded Private Society / Association (Non –profit) Authority / Agency (Arm’s length Government relationship)
Primary service type
Operations Training
Qualifications
Post-secondary educationProvide the name of the Granting Institution
Certifications, accreditations and endorsements
Field of Speciality
Field
Number of years
Documented hours per year
Responsibilities/Duties
Field of Speciality
Field
Number of Years
Documented hours per year
Responsibilities/Duties
Field of Speciality
Field
Number of years
Documented hours per year
Responsibilities/Duties
Field of Speciality
Field
Number of years
Documented hours per year
Responsibilities/Duties
Checklist
Attachment checklistPlease check you have the following ready for consideration by the IRIA
Signed Confidentiality Agreement Cover Letter Resume PDF Certificates, Diplomas, Documented Hours Two reference letters Application fee via PayPal (upon completion of this form you will be directed to fee payment)
Uploading certificates and documentsUse the following to browse for documents on your computer to upload to IRIA. If you have more than one certificate, then 1. Highlight all the files to be sent 2. Right click, choose 'Send To' and then choose 'Compressed (zipped) folder' 3. Upload the ZIP file
Resume
Cover Letter
Signed Confidentiality Agreement
CertificatesIf you have more than one certificate, you may wish to zip your files together
Documented Hours
Reference lettersIf you have more than one certificate, you may wish to zip your files together
Declaration
I wish to apply for membership with the International Rescue Instructor Alliance as a: *
I would like my membership *
Listed Unlisted
I declare that the information in this application is true, correct and complete *
I agree I disagree
Membership FeesAssociate (Non-Certified, Individual) Member: US$89/yr
Professional (IRIA Certified* Instructor) Member: US$39/yr
Associate (Non-Accredited) Organization: US$199/yr
Professional (IRIA Accredited*) Organization: US$99/yr
Verification

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Becoming a member

Personal Information

Occupation Details

Qualifications

Field of Speciality

Field of Speciality

Field of Speciality

Field of Speciality

Checklist

Declaration

Verification