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)
___________________
($10.00 discount for REI Co-op members. REI member number: ________________ )
I the undersigned understand and agree that all course deposits are non-refundable and non-transferable under all circumstances, except as noted above.
Signature:_________________________________________________________
COURSE INFORMATION AND
COSTS:
Basic Wilderness First Aid
(includes textbook) $90.00
Basic and Advanced Wilderness First Aid (includes textbooks and
CPR certification) $175.00
Basic & Advanced WFA and Wilderness First Responder (AWFA
to WFR “bridge”- includes textbooks and CPR) $350.00
Wilderness First Responder
with previous AWFA certification (includes textbook) $175.00
WFR Refresher $100.00
Single Rescuer CPR $40.00
Make all checks payable to “Emergicare Medical Training" and mail to:
Emergicare Medical Training Div.
Backcountry Trail Patrol Association,
Inc.