Ohio Region - National Ski Patrol

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♦	Central Division NSP

First Name:

Last Name:

Address:

City: State:

Zip:

NSP membership #:

Evening Phone:

Daytime Phone:

Cell Phone:

Patrol:

Email:

Classification to Attain:

Senior Patroller (formerly Auxiliary)
Senior Alpine Ski/Tele Patroller
Senior Alpine Snowboard Patroller
Senior Nordic Patroller

DIVISION APPLICATION INFORMATION

Electives Completed and Year Completed (3 for Senior Alpine/Nordic Patroller; 4 for Senior Patroller):

1)
2)
3)
4)

A copy of this application will be emailed to your patrol director for approval.