Trainer Application Date* MM slash DD slash YYYY Name* First Last 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 Best contact telephone*Email* Enter Email Confirm Email Business Name Current Occupation Select one:*If you have never belonged to the BBEA before, please also complete the application for membership (https://buteykoeducators.org/register/) I am a current BBEA member I am a returning BBEA member I am not a BBEA member, but am applying Which trainer level are you applying for?* Full trainer (you teach level 1 and level 2 trainees) Specialty trainer (you teach current Educators a specialty) You teach non-educators a specialty If you are a new applicant and are requesting trainer level, please describe your training and previous experience.List any Degrees/Certifications not mentioned in previous documentation. (Attach copies of diploma etc)Degree/Certification copiesAny declared degree or certification must be accompanied by a copy of the degree or certification. Drop files here or Select files Max. file size: 256 MB. Has your Buteyko teaching been evaluated by a Trainer?*If the evaluation was in person or you submitted a video of your teaching, select yes. Otherwise select no. Yes No If Yes, by whom?Please enter the name of the trainer When? MM slash DD slash YYYY How many clients/patients have you taught?*You may be asked to support this number with documentation.Please enter a number from 0 to 999999.How many case studies have you completed?*If your trainer did not require case studies, you may be asked to write up case studies from your client/patient records. If you have written papers or presented cases at a conference or webinar, those count as completed case studies. Do you have at least 14 BBEA CE units in the last 2 years?If you are a new member, this is not a requirement. Yes No I am a new applicant for membership Papers/Webinars:Please list any publications you have authored, and any webinars you have presented. Indicate case studies.Attach copies of case studiesMax. file size: 256 MB.How many Buteyko webinars/conferences have you attended?*If you are a new member applicant, enter N/A How many webinars have you presented?*If you are a new member applicant, enter N/A Have you presented at a conference?*If you are a new member applicant, we understand it may not be a BBEA conference Yes No When and where?Have you done YouTube videos or TED talks? Please itemize.Have you shadowed a trainer?*(Be in attendance and assist a Trainer at one of his/her trainings) Yes No Who did you shadow and when? Do you have a Trainer who can shadow your first training?*A trainer must be present in your first solo training. If you are an experienced trainer, this no longer applies. Yes No I am an experienced Buteyko trainer I am an experienced specialty trainer If yes, who?* If you plan to train new educators: Have you downloaded the basic teaching materials provided for a training and reviewed them? Do you plan to make additions or changes to the basic materials? Do you have an agenda for your training? What changes / additions do you plan to make at this time?Please expand on your choices aboveIf you plan to do specialty training, please describe it*Please upload your specialty training agendaMax. file size: 256 MB.
