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. 

Question Title

* 1. First Name

Question Title

* 2. Last Name

Question Title

* 3. Employment or Sponsoring Agency

Question Title

* 4. Please list the ZIP CODE of your PRIMARY Employment Agency

Question Title

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

Question Title

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

Question Title

* 7. Please select your Professional discipline.

Question Title

* 8. List your Instructor Certifications or Instructor Qualifications you may have

Question Title

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

Question Title

* 10. I confirm that I am 18 years of age or older.

Information will be emailed to you soon after the 'deadline' of the class to notify you of acceptance or waiting list status.    
Should you have questions - Contact  Cathy White, GEMSA Program Coordinator at program@georgiaemsassociation.com
This Program is made possible by State of Georgia funding provided through the Georgia Trauma Care Network Commission.

T