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This Program is made possible by the State of Georgia funding provided through the
Georgia Trauma Care Network Commission     
You must either live in Georgia or work in Georgia to apply to attend this class.


We are having to implement a SEAT FEE for GEMSA sponsored Classes due to the 'no shows' we are having the day of class. A $30 Seat Fee will be requested at the end of this application by Credit Card - There is NO Cancellation Policy - If you do not show up after submitting your application and paying your seat fee you will not receive a refund of any type.

After you attend class - within a 45 day period you will receive a $20 reimbursed to your credit card.

The Grant pays for Class, Lodging and Meals - the only cost to the student will be the $10 mentioned above and the students transport to and from the class.

This program has been called a "discovery of leadership". It is designed not only to help the participant become a better leader but also a better follower. This course teaches principles that are applicable at work as well as in the home and is relevant to experienced or new leaders. It stresses the development of core values such as character, integrity, trust and respect and servant leadership among others. The Axioms of Leadership course emphasizes the importance of core values through the participants' efforts with their team in the Warrior Stations. These physically and mentally demanding efforts must be experienced personally in order to completely understand them. (This course does have some physical demands on you)

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* 1. By checking YES on this box the applicant has read the prior paragraph and fully understands the Seat Fee policy and You either live or work in Georgia (this is is a requirement to attend this class)

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* 2. First Name

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* 3. Last Name

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* 4. EMAIL address

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* 5. Contact Phone Number

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* 6. Home Street Address

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* 7.
City of Home Address

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* 8. Zip Code of Home Address

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* 9. COUNTY you live in (NOT Country)

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* 10. Gender

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* 11. What is your Race or Ethnicities

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* 12. What is your Age

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* 13. Place of Employment or School you attend

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* 14. Job Title or Role

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* 15. Years of Service at CURRENT Job

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* 16. Years Employed in your current field

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* 17. Street Address of Employer or School

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* 18. City of Employer or School

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* 19. Zip Code of Employer or School

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* 20. COUNTY of Employer or School (NOT Country)

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* 21. Location of Course you wish to attend:
The Course in January 19-20-21, 2025 is now at a waitlist status..... If that is the class you are interested in please do not complete the application and contact Cathy White

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* 22. Lodging at the Facility is required - Double Occupancy.  Each Cabin sleeps 3-4 people.  Please select your gender.

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* 23. I understand that I must attend all days and complete all necessary course requirements in order to receive a completion Certificate.

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* 24. By registering for this class you are making a commitment to attend this class. If you register and 'do not show' for the class or cancel within 3 weeks of the class - you may become ineligible to attend any Georgia Trauma Commission funded course for 1 year and you will forfeit you 'seat fee'.

If you have any questions - Please contact Cathy White at program@georgiaemsassociation.com
This Program is made possible by State of Georgia funding provided through the
Georgia Trauma Care Network Commission.
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