BDLS Registration - May 15, 2012
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Please complete the following information to register for the Basic Disaster Life Support training sponsored by the Region 7 Medical Disaster Preparedness Network on Tuesday, May 15, 2012 at the Grayling Michigan National Guard Base. Your registration will be confirmed and additional course details provided via email in advance.

1. First Name

First Name

2. Last Name

Last Name

3. Degree / License

Degree / License

4. Organization Name

Organization Name

5. Address (for mailing course text book and/or certificate of completion)

Address (for mailing course text book and/or certificate of completion)

6. City

City

7. State

State

8. Zip Code

Zip Code

9. Phone Number

Phone Number

10. E-mail Address

E-mail Address

11. Are you also planning to register for Advanced Disaster Life Support (ADLS) training scheduled for May 16 & 17 in Grayling? (If Yes, please note that separate registration is required.)

Are you also planning to register for Advanced Disaster Life Support (ADLS) training scheduled for May 16 & 17 in Grayling? (If Yes, please note that separate registration is required.) Yes

BDLS Registration - May 15, 2012Exit this survey