Exit this survey Sierra Club (NC Chapter) New Outings Leader Application New Leader Application Question Title * 1. Your contact information: First name Last name Address City State Zip Email address Phone Question Title * 2. How old are you? under 18 18-22 23-29 30-39 40-49 50-59 60-69 70-79 Other (please specify) Question Title * 3. Have you participated on a Sierra Club Outing before? No Yes If yes, please tell us about recent outings/trips you have been on (where/when/activities/leaders' names) Question Title * 4. Why do you want to become an Outings Leader for the Sierra Club? Question Title * 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) Question Title * 6. Please check off all outdoor activities you are interested in leading: Walking Hiking Canoeing Kayaking Bicycling Camping Other activities (please specify) Question Title * 7. Please list technical skill areas (i.e. kayaking, mountaineering, backcountry chef, bicycle repair, etc) in which you feel you are competent: Question Title * 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) Question Title * 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 Question Title * 10. If you have first aid training, when is the last time you took it (month/year)? Question Title * 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 Question Title * 12. Are you currently, or have you been, an outdoor leader for another organization? No Yes If yes, what kinds of groups have you lead? Where, and for how long? Question Title * 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. Done