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 *
AddressAddress Line 2CityState / Province / RegionPostal / Zip CodeCountry
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 ResponseEmergency Response (armed)Industrial SafetyNatural Resource ManagementProfessional GuidingPersonal / Public SafetyOutdoor Recreation
What responsibility do you have?
OperationsOperations ManagementInstructingTraining ManagementRisk ManagementHealth and SafetyLegalFinancialMarketingResearchProgram DevelopmentOther
Organization Type
GovernmentNGOPublically TradedPrivateSociety / Association (Non –profit)Authority / Agency (Arm’s length Government relationship)
Primary service type
OperationsTraining

Qualifications
Post-secondary education
Provide the name of the Granting Institution
Certifications, accreditations and endorsements *
Provide the name of Training Organizations, Levels and Dates
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 checklist
Please check you have the following ready for consideration by the IRIASigned Confidentiality AgreementCover LetterResumePDF Certificates, Diplomas, Documented HoursTwo reference lettersApplication fee via PayPal (upon completion of this form you will be directed to fee payment)
Uploading certificates and documents Use 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
Certificates If you have more than one certificate, you may wish to zip your files together
Documented Hours
Reference letters If 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 *
ListedUnlisted
I declare that the information in this application is true, correct and complete *
I agreeI disagree
Membership Fees Associate (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