TRAUMA SKILLS PROCEDURE LAB LIMITED SPACE- Serious Inquiries Only* Please Only Sign Up if you are Planning to Attend - Don't Take a Position Away from a Student Who Can Attend

New TRAUMA SKILLS PROCEDURE LAB **LIMITED SPACE

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.

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* 1. First Name (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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* 2. Last Name

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* 3. Email Address

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* 4. Contact Phone Number

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

Home Street Address

Street Address #2 (i.e. apartment number) if no secondary enter N/A

City

State

Zip Code

County

Gender

Race/Ethnicity

Age

Place of Employment

Job Title/Role

Years at Current Job

Years Employed in Current Field

Emplyment Location Street Address

Street Address #2 (i.e. Suite Number) if no secondary enter N/A

City

State

Zip Code

County

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* 6. Select the Course Location and Time Slot you Wish to Attend
The only 2 Labs left in this fiscal year with open seats are Dodge and Barrow County

Dodge County April 7 2023 Morning Session 0800-1130 hours

Dodge County April 7 2023 Afternoon Session 1230-1600 hours

Barrow County June 2, 2023 Morning Session 0800-1130 hours

Barrow County June 2, 2023 Afternoon Session 1230-1600 hours

Fulton County May 12, 2023 Morning Session 0800-1130

Fulton County May 12, 2023 Afternoon Session 1230-1600 hours

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* 7. Are you and EMS Provider?

First Responder or EMT - Basic

EMT - I

EMT - A

Paramedic

Firefighter

Firefighter/EMT

Nurse

Respiratory Therapist

other

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

Question Title

* 1. First Name (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)

Question Title

* 2. Last Name

Question Title

* 3. Email Address

Question Title

* 4. Contact Phone Number

Question Title

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

Question Title

* 6. Select the Course Location and Time Slot you Wish to Attend The only 2 Labs left in this fiscal year with open seats are Dodge and Barrow County

Question Title

* 7. Are you and EMS Provider?

* 6. Select the Course Location and Time Slot you Wish to Attend
The only 2 Labs left in this fiscal year with open seats are Dodge and Barrow County