Instructor Training

Sponsor/Host: WMAI Canada

Location: - Canada

Dates: 3/27/2020 - 3/29/2020

Contact Info:
for registration or
course questions

Britt Needham
1-877-WILDMED

Registration for this Event is closed.

	Instructor Name	Location	Certifications
	Britt Venn	ON, Canada	PCP

Please complete the following form, which will be forwarded to the course sponsor, who will assist you in completing the registration process.

Fields with * are required.

Name*
First Last
Please enter the name of the person who will be taking the course.
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Fax
Email*
Are you using this course to recertify?*
(please refer to WMA's recertification policies)
What certification do you hold?
****If you are using this course to recertify a WMA WEMT if is your responsibility to make sure sponsor knows when registering, and to inform the instructor on the first day of class.**
Certification Expiration Date
Date Format: MM slash DD slash YYYY
Is it from WMA?*
Comments Or Questions
Thank you for expressing interest in this course. Someone from the Sponsoring organization will be in contact to complete your registration. Please note - filling out this form does not register you for the course, you must talk to the sponsor and pay the course fee to finalize registration.
Sponsor Email
Name
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