Key Technical Instructor Application

First Name: Last Name:
Phone: Email:
City: State: Zip Code:

I have read and agree to the contents of the Non-Disclosure Agreement.

Key Instructor Expectations

1. Have a through knowledge of UWLD models
2. Understand technical and innovative Key Features of UWLD products
3. Promote & Support the UWLD brand with honesty and integrity
4. No direct competition with UWLD dealers
5. Maintain UWLD MAP Policies

I understand and agree to the above listed Key Instructor Expectations.

Current Technical Agencies

Agency Name Instructor Number Highest Certification Level
Number of Years as a Certified diver:
OW Agency:
OW Certification #:
Number of years as a technical instructor:
Number of technical certifications YTD:
Total technical certifications last year:

List Your Instructor Certifications

List the type certifications you have taught in the last year

Do you presently have & use UWLD products?

Please fill in up to five UWLD products with model & generation of product:
Please fill in up to five products from other manufacturers with model:

Are you affiliated with a dive shop?

If yes, are they a UWLD dealer? YesNo
If yes, which dealer?

In 500 words or less tell us why you are the right choice as a UWLD Key Tech Inst.

After submitting this form and it has been reviewed, we will contact you.
Please wait until we have reviewed this form for us to contact you.