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 FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin 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 Committee InterestPlease indicate which committee(s) you would like to participate in*select all that apply Approved Provider Committee Ethics and Standards Committee Item Writing/Examination Development Committee Specialty Certificate Committee General EducationPlease select the highest level of education attained*High School (or equivalent)Some CollegeTechnical/Vocational CertificateCollege Degree (2 years)Bachelors Degree (4 years)Masters DegreeHigherMassage Bodywork TrainingTotal hours of your basic training program*under 500 hours500 - 999 hours1000+ hoursI have not completed a basic massage training programYear that your basic training was completed*School where your basic training was completed*Additional hours of massage/bodywork training*under 100 hours100 - 299 hours300 - 499 hours500 - 999 hours1000+ hoursExperience in Massage/BodyworkAre you currently practicing?YesNoI am not nor have I ever been a massge therapist or bodyworkerYears in practice*Type of Employment*Full-time (75% of income)Part-timePlease 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.YesNoAre you able to download and/or interpret Microsoft Word Documents?*YesNoPlease 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
