Emergicare Medical Training Application
(Print form and mail into register for classes)
Individual enrollment
in all Backcountry Trail Patrol Association/Emergicare Medical Training, Inc.
(Emergicare) courses is limited. To reserve a space in an Emergicare course,
please return your application form and the appropriate tuition/deposit to
Emergicare. Courses under $200.00 require tuition payment in full
at the time of registration. (A non-refundable deposit of $100.00 is required
for Wilderness First Responder-level courses, and will be applied to the course
cost.) Full, non-refundable and non-transferable tuition, is due 14 days prior
to the course. However, in the event of a student being unable to attend a
course they have registered for, their payment may be applied to another
Emergicare course at the same level, upon approval by Emergicare Medical
Training. Prior to 14 days before the course date, tuition may be refunded,
minus a 15% administrative fee.
If a program is cancelled by Emergicare due to low enrollment, the full deposit/tuition will be refunded.
REGISTRATION INFORMATION
Name: ___________________________________________________
Email: ___________________________________________________
Address: __________________________________________________
City:
Phone: ____________________ Permanent Phone: ________________
Course Dates:______________ Course Location:_________________
Will you be 18 when the course starts? Yes ____ No ____ (Students under 18 must have parent/guardian consent)
Are you recertifying certification? Yes ____ No ____
(If "yes" please bring a copy of the certification card to the course)
Course recertifying: WFA ____ WAFA ____ WFR ____ WEMT ____ Certification from:_____________
PAYMENT AMOUNT: (See below) ___________________
I the undersigned understand and agree that all course deposits are non-refundable, and non-transferable under all circumstances.
Signature:_________________________________________________________
COURSE INFORMATION AND
COSTS: (Note: Price changes of 10/1/2007 reflect the increased price of the
new, third edition of the AAOS/WMS Wilderness
First Aid textbook.)
Notice: Effective December 1, 2007, Emergicare Medical Training and the
Backcountry Trail Patrol Association will no longer be offering new Wilderness
First Responder (WFR) courses, until further notice.
Basic Wilderness First Aid (includes new AAOS/Wilderness Medical Society textbook) $120.00
Advanced Wilderness First
Aid (must have current Basic WFA Certification - includes AAOS CPR textbook)
$80.00
Basic and Advanced Wilderness First Aid (includes AAOS/Wilderness
Medical Society and AAOS CPR textbooks and certification) $190.00
WFR Refresher – 24 hours $150.00 ($190.00 with 2004 2nd. Edition NOLS WFR textbook)
Basic CPR $35.00 (Skills training only-no textbook.)
AAOS Basic Life Support CPR/AED with textbook $50.00
Make all checks payable to “Emergicare Medical Training" and mail to:
Emergicare Medical Training Div.
Backcountry Trail Patrol Association,
Inc.