Tec Sidemount Inst App

___ 1.
PADI Tec Instructor (or TecRec Instructor with a higher rating)

___ 2. Be a PADI Tec Sidemount Diver (or have a qualifying certication from another training organization)
___ 3. I have logged at least 20 technical sidemount dives including 10 with 3 or more cylinders (two mains and
at least 1 stage/deco cylinder)
___ 4. Have successfully complete the Tec Sidemount Instructor Training course.
Successfully completed a Tec Sidemount Instructor Training Course (to be completed by PADI Tec Sidemount Instructor
Trainer only)
Course Location ____________________________________________________________ Date (D/M/Y) ___________________
Instructor Trainer Name ______________________________________________________ PADI Number _______________
Instructor Trainer Signature _______________________________________________________________________________
PADI Dive Center/Resort Name _______________________________________________ PADI Number ______________
1. PADI Tec Instructor (or TecRec Instructor with a higher rating).
2. Tec 50 Diver (or have a qualifying certication from another training organization)
3. Have logged at least 50 technical sidemount dives including 30 with 3 or more cylinders (two mains and at least one
stage/deco cylinder)
4. PADI Tec Sidemount Diver (or have a qualifying certication from another training organization)
Applicant Signature _________________________________________________ Date _______________________________
D/M/Y
TEC SIDEMOUNT
INSTRUCTOR APPLICATION
Applicant Name___________________________________________________ PADI Number ___________
Mailing Address ____________________________________________________________________________
City _________________________________________ Province/State ______ Postal/Zip Code ________
Country ______________________________________ Email ______________________________________
Home Phone _________________________________ Business Phone _____________________________
FAX _________________________________________ Sex M F Birthdate ___________________
D/M/Y
REQUIREMENTS FOR APPLICANTS COMPLETING INSTRUCTOR TRAINING COURSE
TEC SIDEMOUNT INSTRUCTOR
REQUIREMENTS IF MAKING DIRECT APPLICATION
Product No. 10617 (12/11) Version 1.0 PADI 2011
Note: Your application may need to include documentation/proof of meeting these requirements by including photo-
copies of instructor certication cards and other relevant course certications and qualications. Log entry copies or
print outs must specify dates, depths, locations, times and gases used. Verication and signatures provided by witnesses
(divers and instructors of courses assisted) must provide the same information.
INSTRUCTOR APPLICANT ACKNOWLEDGEMENT
I certify that the information on this application is true and correct to the best of my knowledge and understanding,
and that this application is subject to approval by PADI.
Applicant Signature ____________________________________________________ Date ____________________________
D/M/Y
Tape / Attach a
4.5 cm x 5.7 cm
1
3
4
" x 2
1
4
" (approx.)
Head and Shoulder Photo
PRINT NAME ON
BACK OF PHOTO
Coin Machine Photos OK
No Dark Glasses
CHECKLIST
Application completed in full
Requirements completed
Copies of qualifying certification, if required
Applicant and verifying instructor signatures
One photo attached
See price list for fee
PLEASE DO NOT WRITE IN THIS SPACE
Date ____________________________
Amount _________________________
PAYMENT METHOD
See current price list for payment information.
MasterCard VISA American Express
Discover Card JCB Maestro (UK only)
Check/Bank Draft No.* ______________________________
*Check/Bank Draft must be payable in the currency of the PADI
Office the application is submitted to.
Card Number _________ __________ __________ __________
Card expiration date _______________________________________
Cardholder Name __________________________________________
Please Print
Authorized Signature _______________________________________
Recd _________________________ Entrd _________________________ Shpd ________________________
MAIL TO Your PADI Office
Attn. PADI Tec Sidemount Instructor Certification
For mailing information, see current price list or visit padi.com.

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___ 1.

PADI Tec Instructor (or TecRec Instructor with a higher rating)

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