U.S. Ski & Snowboard

2023-24 U.S. Ski & Snowboard Medical Pool - PT/AT

Please complete the following form to request your U.S. Ski & Snowboard Medical Pool membership for the 2023-24 season.

Note: You may be required to complete one or more of the below membership requirements in order to activate your Membership:

> SafeSport Training: Due every season.
> Background Screening: Due every other season
> Introduction to Avalanches: Due every other season.

This form will be processed during normal business hours of Monday-Friday, 8am-5pm Mountain Time.

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U.S. Ski & Snowboard Member Information

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U.S. Ski & Snowboard Waiver and Policies

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U.S. Ski & Snowboard Bonus Packs

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Checkout

Returning or New Medical Pool Applicant *
New Applicant Returning Applicant
U.S. Ski & Snowboard Member Name * First Last
Please enter your legal name.
Date of Birth * MM / DD / YYYY
Gender *
Female Male
Gender Identity *
Female Male Non-Binary Transgender/Gender Non-Conforming Other Prefer Not to Respond
Do you identify as LGBTQ+ (Lesbian, Gay, Bisexual, Transgender, Queer, plus more)? *
Yes No Other Prefer Not to Respond
Military Status
Active Military Veteran

We thank you for your service.
What is your Ethnicity? *
American Indian or Alaska Native Asian Black Hispanic or Latino Mixed Race Native Hawaiian or Pacific Islander Prefer Not to Respond White
Email *
Physical Mailing Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Last MESS course attended:
Date Last MESS course attended: MM / DD / YYYY
Last traveled with team (team, year, location): *
Please select your gender specific jacket size *
Extra Small Small Medium Large Extra Large Extra Extra Large
Would you like to receive a printed member card? *
Yes No
Would you like to receive the Sports Medicine Newsletter? *
Yes No
Medical Specialty *
Physician Athletic Trainer Physical Therapist Other
*If selected "Other" from Medical Specialty, please elaborate
Years of Training: *
Fellow Attending 1-5 years Attending 10+ years
Shipping Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Number * ### - ### - ####
Primary Medical Insurance Company Name: *
Primary Medical Insurance Policy/ID Number: *
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U.S. Ski &amp; Snowboard

U.S. Ski & Snowboard