Reinstatement Process Form Step 1 of 2 50% Nationwide Reinstatement Policy The following reinstatement process gives former PSIA-AASI members a path to return to activecertified membership. The reinstatement process provides former members a path to return toactive membership without loss of their prior certification level. The reinstatement process can occur at any time during the year and is standardized for all disciplines. This process is not required if educational units are current at the time of reinstatement.Members also have the option of going through the certification process if they would likeanother way to become an active certified member. Reactivation: 1-Year Membership Lapse Members who have missed a year of membership dues will be required to paylast year’s membership dues (+ late fee) as well as the current year’smembership dues and continue to follow CEU requirements. 2-4 Year Membership Lapse Members will be required to pay a $210 reinstatement fee as well as the currentyear’s dues. Members will be required to earn 6 CEUs for each year they have not paid dues. Members who wish to become an inactive certified member must fulfillguidelines for inactive members. The person’s membership card will indicate updated status. Recertification: 5 Years or More Lapsed Membership: Members will be required to pay a $380 reinstatement fee as well as the currentyear’s dues. Members will be required to earn 24 CEUs within one season. Members will beresponsible for working with – and getting approval from – their division fortheir personal recertification plan. The person’s membership card will show inactive certified status until theirpersonal recertification plan is complete. *Individuals wishing to re-join PSIA-AASI can do so as an Alumni member if they meet qualifications or as a Registered Member.Name* First Last Email* Member ID #Primary Phone*Primary Phone Type*CellHomeWorkOtherAlternate PhoneAlternate Phone TypeCellHomeWorkOtherAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican 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 RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzechiaDenmarkDjiboutiDominicaDominican 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 RicoQatarRéunionRomaniaRussian FederationRwandaSaint 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 TobagoTunisiaTürkiyeTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Date of Birth How shall we follow up with you?*EmailPhoneEither is fine Reinstatement Circumstances*Inactive Member Wishing to go Active AgainInactive Member Wishing to go to Alumni StatusAlumni Member Wishing to Regain Certification1 Year of Lapsed MembershipTwo to Four Years of Lapsed MembershipFive or More Years of Lapsed MembershipPlease choose which is closest to your current circumstances regarding your reinstatement.Your Primary Discipline*AlpineAdaptiveSnowboardTelemarkCross CountryHighest Certification Level*Level 1Level 2Level 3Date of Last Membership* Snowsports SchoolSnowsports School Director's NameMembership Summary*Please provide some details about your past membership. (Including your past join date if at all possible.)Additional InformationIs there any additional information about your prior membership, which might be helpful in considering your application?