The course is funded by the Ga. Trauma Commission.

You must either live in Georgia or work in Georgia to attend this class. If you do not meet this requirement and proceed to register you will not be allowed to attend nor will you be refunded any part of the seat fee.

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 60 day period you will receive $20 returned to your credit card.

If you cancel prior to the class (for any reason) you will not reimbursed any funds.

Question Title

* 1. First Name

Question Title

* 2. Last Name

Question Title

* 3. Email Address

Question Title

* 4. Contact Phone Number

Question Title

* 5. Street Address ( ie 123 Main Street)

Question Title

* 6. City of Address

Question Title

* 7. Zip Code

Question Title

* 8. COUNTY (not country.... ie not United States)

Question Title

* 9. Gender

Question Title

* 10. Race

Question Title

* 11. What is your Age

Question Title

* 12. What is your place of Employment or School you attend

Question Title

* 13. What is your Job Title or Role

Question Title

* 14. Years of Service at Current Job

Question Title

* 15. Number of Years in Your Current Profession (years at all jobs)

Question Title

* 16. Employment or School Street Address

Question Title

* 17. Employment or School City Location

Question Title

* 18. Employement State Location

Question Title

* 19. Employment or School Zip Code Location

Question Title

* 20. Employment or School COUNTY (not Country)

Question Title

* 21. Confirm the Location of Course in which you wish to attend:

Question Title

* 22. 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, E00201, A04011, P001882

Question Title

* 23. Are you and EMS Provider?

Question Title

* 24. I understand that I must complete the 2 day classroom and 'hands on' portion of the class if I am to receive a certificate.

Question Title

* 25. I understand that if I do not pay the Seat Fee requested at the end of this application - my Seat in the class is not secured. I also understand should I cancel for any reason once I register for a class that I will not be refunded any portion of the Seat Fee.

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

Should you have any questions feel free to reach out to Travis McCoy, Program Coordinator at specialops@georgiaemsassociation.com
( Privacy & Cookie Notice

T