Supraglottic Airway Endorsement Course Application

1.What is your first and last name as they appear on your DOH Credential?(Required.)
2.What is your Washington State Department of Health EMS Credential number?(Required.)
3.Which Mason County EMS agency are you primarily affiliated with?(Required.)
4.What is your email address?(Required.)
5.What is your phone number?(Required.)
6.Please check the boxes to acknowledge the following course completion requirements:(Required.)
7.What are your goals for completing this training?(Required.)