GEMSA Sponsored - McNeil & Company - Emergency Vehicle Operators Course - Instructor Course

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 $25 reimbursed to your credit card .

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* 1. First Name

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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. Home Street Address

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* 6. City of Home Address

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* 7. Zip Code of Home Address

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* 8. COUNTY of Home Address ( Not Country....not United States)

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* 9. Gender

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* 10. Race

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* 11.
What Is Your Age?

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* 12. Information on your Employment or School you attend

Name of Employer or School

Job Title or Role

Years of Service at Current Job

Years of Service in the Profession

Address of Employer or School

City of Address of Emplyer or School

State of Employer or School (ie GA, AL, FL,,,,,,)

Zip Code of Employer or School

County of Employer or School (not Country.... not United States)

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* 13. Location of Course in which you wish to attend:

Fulton County - Atlanta March 17 & 18, 2025

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* 14. Please select your Professional discipline.

First Responder, EMT or Paramedic

Firefighter/Medical Personnel

Firefighters no Medical Training

Other (please specify)

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* 15. 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 these examples provided (R045678, I016240, A04011, P001882)

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* 16. List your Instructor Certifications or Instructor Qualifications you may have

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

Yes

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* 18. I confirm that I am 18 years of age or older.

Yes

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* 19. 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 the class that I will not be refunded any portion of the Seat Fee.

Yes

Information will be emailed to you soon after the 'deadline' of the class to notify you of acceptance or waiting list status.
Should you have questions - Contact Travis McCoy GEMSA Program Coordinator at specialops@georgiaemsassociation.com

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

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* 1. First Name

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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. Home Street Address

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* 6. City of Home Address

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* 7. Zip Code of Home Address

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* 8. COUNTY of Home Address ( Not Country....not United States)

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* 9. Gender

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* 10. Race

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* 11. What Is Your Age?

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* 12. Information on your Employment or School you attend

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* 13. Location of Course in which you wish to attend:

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* 14. Please select your Professional discipline.

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* 15. 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 these examples provided (R045678, I016240, A04011, P001882)

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* 16. List your Instructor Certifications or Instructor Qualifications you may have

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

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* 18. I confirm that I am 18 years of age or older.

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* 19. 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 the class that I will not be refunded any portion of the Seat Fee.

* 11.
What Is Your Age?