ARP Certified Ringside Physician Examination Application Please indicate your name as you would like it to appear on your certificate. ACSM/ARP files will reflect this name and address. Please do not abbreviate. Question Title * 1. First Name and MI Question Title * 2. Last Name Question Title * 3. Credentials (MD, DO, or equivalent) Question Title * 4. Email Address Question Title * 5. Please upload a copy of your Medical school diploma DOCX, DOC, JPEG, JPG, PDF, PNG file types only. Choose File Choose File No file chosen Remove File Please upload a copy of your Medical school diploma Question Title * 6. Please upload a copy of your current State/Country medical license DOCX, DOC, JPEG, JPG, PDF, PNG file types only. Choose File Choose File No file chosen Remove File Please upload a copy of your current State/Country medical license Question Title * 7. Please upload your Recommendation Form 1 DOCX, DOC, JPEG, JPG, PDF, PNG file types only. Choose File Choose File No file chosen Remove File Please upload your Recommendation Form 1 Question Title * 8. Please upload your Recommendation Form 2 DOCX, DOC, JPEG, JPG, PDF, PNG file types only. Choose File Choose File No file chosen Remove File Please upload your Recommendation Form 2 Question Title * 9. Please upload a completed clinical experience documentation form This is to be completed by state/country athletic commission DOCX, DOC, JPEG, JPG, PDF, PNG file types only. Choose File Choose File No file chosen Remove File This is to be completed by state/country athletic commission Question Title * 10. Please upload a copy of your Board Certification Certificate or documentation of board eligibility. If this is not applicable, please upload a written explanation of why not. DOCX, DOC, JPEG, JPG, PDF, PNG file types only. Choose File Choose File No file chosen Remove File Please upload a copy of your Board Certification Certificate or documentation of board eligibility. If this is not applicable, please upload a written explanation of why not. Question Title * 11. Please upload the Online Certified Ringside Physician Listing Application Form DOCX, DOC, JPEG, JPG, PDF, PNG file types only. Choose File Choose File No file chosen Remove File Please upload the Online Certified Ringside Physician Listing Application Form Done