ACA Certification Course Registration Form ‐ 2009
American Canoe Association / 1340 Central Park Blvd ‐ Suite 210 – Fredericksburg, VA 22401 / 540.907.4460 / 888.229.3792 fax /
This form is to be submitted with all associated fees, to the ACA National Office by the head Instructor
Trainer / ITE. Please review and complete this entire form before submitting to the ACA.
Certification Course Information (see key on page 2 for reference)
All Certification Course participants (Instructor Candidates)
are required to have the following prior to attending an Instructor
• ACA Membership
Instructor Certification = annual member
o Skills Assessment = intro member
• ACA SEIC registration *
• ACA Instructor’s Manual
• ACA Student Packet
Instructor’s Manuals and Student Packets can be ordered by calling
* SEIC registration (annual) is required upon completion of the
instructor certification exam.
City / State:
City / State /
Head IT / ITE:
I am requesting ACA Insurance for this course.
If yes, please attach the ACA Insurance Request Forms.
Please post this course on the ACA ‐ American Paddler Course Connection webpage
As the ACA Instructor in charge of this event, I hereby agree that the course/workshop will be conducted in accordance with all
ACA requirements, risk management, and all other rules, guidelines and conditions established by the ACA. I have read and fully
understand all sanctioning requirements established by the ACA. I have personally inspected the event site(s) and I attest to the
fact that such site(s) are appropriate for use in this event and free of undue hazards.
ACA Certification Course Registrati