HEALTH REGISTRATION

HEALTH REGISTRATION

Please Note: THIS IS NOT A CAST or CAST-FSC COURSE. If the minimum number of participants required to operate any course is not reached 45 days prior to a published class start date, the course will be rescheduled and you will be notified. You will then have the option of applying all fees to a rescheduled or different course option. If you choose not to re-schedule, all refundable fees will be returned to your account. Please wait for final course confirmation before scheduling travel.

Course Location *

Name *

First

Last

Phone *

Email *

Organization/Employer *

Website / URL

Staff Position or Organization Role *

Countries of Primary Operation *

Emergency Contact Name *

First

Last

Emergency Contact Email *

Emergency Contact Phone *

Relationship *

List previous medical training, certifications, or experience *

If none, type N/A

Comments, questions, or concerns

How did you hear about this course? *

Payment Amount *

Comment