Request To Host A Course
Please fill out the following form as completely as possible. Once you have filled out and submitted this form, someone from our office will contact you with more information.
* Required
Email address
*
Your email
Hosting Organization
*
Your answer
Full Name First Name Last Name
*
Your answer
Title/Position
Your answer
Email
*
Your answer
Phone #
*
Your answer
Desired Course
*
Choose
Basic Wilderness First Aid
Advanced Wilderness First Aid
Wilderness First Responder Upgrade
Wilderness First Responder
Wilderness First Responder Re-certification
Wilderness EMT
A Wilderness Survival Course
A Working On Ice or Ice Water Rescue Course
Another Course Not Listed
Dates Requested
*
Your answer
Location You Want To Host Course
*
Your answer
Location Amenities
Tables & Chairs
Electricity
Projector
Projector Screen
Restrooms
Kitchen
Indoor Sleeping Accommodations
Tenting or outdoor sleeping accommodations
Wilderness or outdoor nature area (sports fields do NOT count)
Parking
Internet (ethernet or wireless)
Forested Area
Other:
Additional Amenities
Your answer
Anticipated # of Students
*
Your answer
Private or Public?
Choose
Open To The Public
Private (Your Members Or Staff Only)
Comments/Questions:
Your answer
Submit
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