Register to Become a Member of the Canadian Powerskating Association

* all fields are required

Member Type:: Individual (coach, player, consultant, etc), annual membership dues of $200
Organization (a team, group, association, etc), annual membership dues of $550
   
First Name:
Last Name:
Email Address:
Confirm Email Address:
Company/Club/Organization Name:
Status/Type:
Phone Number 1:
Phone Number 2:
Address:
City:
Province:
Postal Code:
   
Date of Establishment:
   
Insurance: Do you carry insurance for your programs?

If so, please include the name of your insurance company, contact information and level of coverage. All members will be required to provide proof of current insurance to the asssociation.

   
Additional Information: Please check all that apply:

 My/our primary focus is teaching powerskating
   I/we have never been charged or convicted of a criminal offence
   My/our participants wear protective gear
   I/we carry first aid certification (all members will be required to provide proof of certification)
   I/we operate year-round
   
Experience: Please describe the powerskating involvement and experience of you and/or your instructors:
   
Post Secondary: Do you have any related post secondary, coaches levels and/or certifications?
   
Skate(s): Please indicate the type of skate(s) you and/or your instructors teach your program in:
   
Participants: Please indicate your number of participants per year and locations:
   
Options:  I would like to receive email updates from the CPA
   
Terms of Membership: I acknowledge all information provided is accurate, complete and truthful. I will provide the Canadian Powerskating association with all requested documentation to ensure my membership is in good standing. It is the sole responsibility of the member to notify the Canadian Powerskating association of any changes in Insurance, first aid certification, criminal background occurrences. Failure to provide truthful and accurate information can and will result in suspension and or termination from the Canadian Powerskating association.

 I agree to the terms of membership and confirm that the information I provided is accurate