"The Difficult Airway Course: EMS" at Stony Brook Medicine on August 4th-5th, 2018
Please complete this Course Registration for "The Difficult Airway Course: EMS", held at Stony Brook Medicine from August 4th to August 5th, 2018 (16 hour course). The course is hosted by the Division of EMS, Department of Emergency Medicine, Stony Brook University Hospital. Once you register, you will be contacted via the e-mail address provided (this may take several days), with course information and payment details. Thank you for your interest!
First Name *
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Last Name *
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Street Address *
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City *
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State *
ZIP Code *
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Phone Number (with Area Code) *
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E-Mail Address *
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What is Your Current Provider Level? *
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What is your state license/certification/EMT #? *
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What is your state license/certification/EMT expiration date? *
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Do you currently hold certification with the National Registry of EMTs? *
If you do currently have a National Registry certification, what is you NREMT number?
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If you have NREMT certification, what is your current National Registry expiration date?
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Have you ever taken the "Difficult Airway Course: EMS" in the past (at anytime or any location)? *
If you have taken the "Difficult Airway Course: EMS" in the past, in what YEAR did you take it?
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