Volunteer Application Step 1 of 3 33% Personal InformationName* First Last Email* Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Are you a Board Certified Therapist, Approved CE Provider, or Assigned School?*select all that apply Board Certified Therapist Approved CE Provider Assigned School none of the above Board Certification Number* Approved Provider Number* Assigned School Code* Resume UploadUpload a copy of your resume* Drop files here or Select files Max. file size: 499 MB. Committee InterestPlease indicate which committee(s) you would like to participate in*select all that apply Ethics and Standards Committee Approved Provider Committee Community Committee Item Writing/Examination Development Committee General EducationPlease select the highest level of education attained* High School (or equivalent) Some College Technical/Vocational Certificate College Degree (2 years) Bachelors Degree (4 years) Masters Degree Higher Massage Bodywork TrainingTotal hours of your basic training program* under 500 hours 500 - 999 hours 1000+ hours I have not completed a basic massage training program Year that your basic training was completed* School where your basic training was completed* Additional hours of massage/bodywork training* under 100 hours 100 - 299 hours 300 - 499 hours 500 - 999 hours 1000+ hours Experience in Massage/BodyworkAre you currently practicing? Yes No I am not nor have I ever been a massge therapist or bodyworker Years in practice* Type of Employment* Full-time (75% of income) Part-time Please tell us more about your other work if applicableWhat is your PRIMARY Massage/Bodywork discipline?AsianContemporaryEnergeticStructural Functional or Movement IntegrationTraditional EuropeanEclectic - Any combination of the aboveWhat is your SECONDARY Massage/Bodywork discipline?*AsianContemporaryEnergeticStructural Functional or Movement IntegrationTraditional EuropeanEclectic - Any combination of the above EmploymentCurrent Position* Work setting*check all that apply to your work setting Chiropractor's office Corporate on-site Education/training Fitness center/health club Group practice - primary care Group practice - rehabilitation Holistic health center Hospital/nursing home/hospice Osteopath's office Physical therapy office Private practice in clinic/home/office Resort/hotel/cruise ship Spa Sports medicine facility Non-massage therapy/bodywork related CommunicationAre you able to receive and respond to e-mail communications on a regular basis?*Most committee business is transacted via e-mail. Yes No Are you able to download and/or interpret Microsoft Word Documents?* Yes No Please provide any additional information that you feel is important, such as describing any special skills, education or experience that you would bring to NCBTMB.Agreement*I understand that the information provided in my application is subject to verification and further discussion during the interview process. I agree to abide by NCBTMB's Code of Ethics and Code of Conduct. All statements made above are true. I agree
