New TRAUMA SKILLS PROCEDURE LAB **LIMITED SPACE **LIMITED SPACE- Serious Inquiries Only*** Ple

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 $20 returned to your credit card. If you cancel prior to the class (for any reason) you will not be reimbursed any funds.

(Understand... once you sign up for a Lab - Please do not email me asking to swap to another Lab - We will not swap you over to another Lab)

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* 1. I fully understand and will comply with the statement above and attest that I either live in Georgia or Work in Georgia...... This course is funded with funds from the Georgia Trauma Commission.

If you do not live in Georgia or Work in Georgia - please do not register for this course.

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* 2. First Name

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* 3. Last Name

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* 4. Email Address

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* 5. Contact Phone Number

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

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* 7. Select the Course Location and Time Slot you Wish to Attend

Lowndes Co is completely full
Floyd Co Afternoon is completely full

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* 8. You understand that if you do not pay the seat fee your application may be rejected

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* 9. Are you and EMS Provider?

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* 10. If you are a State Certified EMR, EMT or Paramedic - Please list your certification number to include the beginning letter and all 6 digits as in the examples below

for example R045684, I016240, E00001, A00001, P001882

This Program is made possible by State of Georgia funding provided through the
Georgia Trauma Care Network Commission.
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