Sierra Club (NC Chapter) New Outings Leader Application

New Leader Application

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* 1. Your contact information:

First name

Last name

Address

City

State

Zip

Email address

Phone

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* 2. How old are you?

under 18

18-22

23-29

30-39

40-49

50-59

60-69

70-79

Other (please specify)

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* 3. Have you participated on a Sierra Club Outing before?

Yes

If yes, please tell us about recent outings/trips you have been on (where/when/activities/leaders' names)

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* 4. Why do you want to become an Outings Leader for the Sierra Club?

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* 5. What kind of outings are you interested in leading? (check all that apply)

Local outings (day trips/hikes/activities)

Overnight trips

Overnight trips <5 days

Overnight trips >5 days

Outings with groups of children/teens (without their parents/guardians)

Other (please specify)

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* 6. Please check off all outdoor activities you are interested in leading:

Walking

Hiking

Canoeing

Kayaking

Bicycling

Camping

Other activities (please specify)

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* 7. Please list technical skill areas (i.e. kayaking, mountaineering, backcountry chef, bicycle repair, etc) in which you feel you are competent:

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* 8. For what populations would you like to lead? (check all that apply)

Adult

Seniors

Disabled

Families

Children

Teenagers/Pre-teens

No preference

Other (please specify)

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* 9. What is your level of First Aid certification?

None

Basic First Aid

Advanced First Aid

Wilderness First Aid

Wilderness First Responder

EMT

Wilderness EMT

Medical Professional (RN, MD, etc. Describe below.)

Medical professional degree

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* 10. If you have first aid training, when is the last time you took it (month/year)?

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* 11. Are you a Sierra Club member?

I'm a current member

I'm a past member

I'm not a member of the Sierra Club

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* 12. Are you currently, or have you been, an outdoor leader for another organization?

Yes

If yes, what kinds of groups have you lead? Where, and for how long?

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* 13. Please use this space for any comments/questions you may have. One of our Sierra Club training organizers will be in touch with you soon!

Please click "Done" to complete your registration. THANK YOU FOR YOUR INTEREST! A member of our Outings Committee will be in touch within 5-10 business days. Contact our Chapter Outings Chair, Kelly Mieszkalski (kellymieszkalski@yahoo.com; 919.624.2225) with questions.