Thank you for attending the Pediatric Safe Transport in Ambulances training sponsored by the Pennsylvania Traffic Injury Prevention Project. Your feedback will help us to improve future events.

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* 1. First Name

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* 2. Last Name

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* 3. Date of Birth

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* 4. EMS Certification Level or Profession (If not an EMS Provider)

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* 5. PA EMS Certification Number (if applicable)

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* 6. Are you a certified Child Passenger Safety Technician?

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* 7. Child Passenger Safety Technician Number (if applicable)

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* 8. County of Residence

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* 9. Overall, how would you rate the event?

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* 10. Upon completion of this class I am better able to:

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* 11. What did you like about the event?

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* 12. What did you dislike about the event?

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* 13. How organized was the event?

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* 14. Was the event length too long, too short or about right?

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* 15. Additional Comments

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