Group Education Request Quick Links Continuing Education Topics Group Education Request Educational Partners Please submit a separate request for each course. * = required fields Contact Name * Organization Name * Title * Profession * —Please choose an option—Emergency Medical ResponderEmergency Medical TechnicianAdvanced EMTParamedicNursePhysicianAllied Health ProfessionalOther Organization Physical Address * Organization Mailing Address If different from physical address Organization Phone Number Please include area code Organization Fax Number Please include area code Primary Phone Number * Please include area code Alternate Phone Number Please include area code Primary Email Address * Alternate Email Address Organization Website Choose a Course Type * If "Other" is chosen, please describe in the comments section below —Please choose an option—ACLSAMLSASLSCPR/AED for LaypersonsCPR/AED/First Aid for LaypersonsBLS for Healthcare ProvidersEMS SafetyGEMSITLSPALSPEARSPEPPPHTLSSkills LabSimulation LabOther Continuing Education Intended Audience * Select all that apply EMREMTAEMTParamedicNursePhysicianOther Healthcare ProfessionalLayperson (Non-Healthcare Professional) Expected Attendance * —Please choose an option—1-6 Participants7-12 Participants13-18 Participants19-24 Participants25-30 Participants31-36 ParticipantsMore than 36 participants Requested Course Date * Requested Course Start Time * Do you have a classroom, conference room, or meeting room available for this course? * ---YesNo What AV equipment is available in your classroom for our use? Media: Blu-Ray PlayerMedia: DVD PlayerComputer: WindowsComputer: AppleSoftware: Microsoft PowerpointSoftware: Microsoft Media PlayerSoftware: VLC Media PlayerDisplay: Projector and ScreenDisplay: Large-Format TVOther (Please describe in comments)No AV equipment is available Comments * Please include any details not already described above Δ PrintFacebookLinkedInTwitterEmail