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 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. 
 
(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

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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?

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

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