The course is funded by the Ga. Trauma Commission.

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.

After you attend class - within a 30 day period you will receive a $20 check mailed to you at the address you listed on your application (or reimbursed to your credit card) along with a small gift.  If you cancel prior to  2 weeks of the class you will receive a $20 reimbursement. If you cancel within 2 weeks of the class or do not show up for the class you will not reimbursed any funds. 

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* 1. First Name

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* 2. Last Name

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* 3. What Georgia County do you work in?

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* 4. Name of Employment Organization or Sponsoring Agency

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* 5. Current Assignment Information

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* 6. Confirm the Location of Course in which you wish to attend:

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* 7. Your contact information  (if no secondary email address available please list N/A)

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* 8. Are you and EMS Provider?

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* 9. I understand that I must complete the 2 day classroom and 'hands on' portion of the class if I am to receive a certificate.

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* 10. I understand that there is not a charge for this course.  

Lodging and Meals - NOT PROVIDED - These are the students responsibility

Information will be emailed to you soon  to notify you of acceptance or waiting list status.    
Should you have questions - Contact Cathy White    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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