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 reimbursement to your credit card to the email address you listed on your application  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. Employment or Sponsoring Agency

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

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* 5. Location of Course you are interested in attending:

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

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* 7. Please select your Professional discipline.

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* 8. I understand that by submitting this application I am applying to be accepted to the course.  I will be notified by email as to my 'acceptance' or 'waiting list' status within 2 weeks prior to course.

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

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* 10. I understand  **  If I realize that I may not be able to attend this class after registering I will contact Cathy White, GEMSA Program Coordinator at program@georgiaemsassociation.com or 678-283-4542 as soon as possible

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* 11.
I understand that when I submit my application - I will be directed to a page to pay a $30 seat fee by credit card. This will secure my seat in the class. After I attend the class or if I cancel by email to klwhitercfd@gmail.com   -  2 weeks prior to class I will receive a $20 refund on my credit card.

If I do not pay my seat fee at the end of this registration I understand that my application will be rejected and I am NOT registered for the class

Should you have any questions about the registration process please 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

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