NICA Course Request

Thank you for choosing to run a course through AdventureMed. Please submit the following information, and we will follow up with you within the next 48 business hours. If you have any questions, please reach out directly to info@adventuremed.com

General Information

MM slash DD slash YYYY
Start Time(Required)
:
MM slash DD slash YYYY
End Time(Required)
:
Will this class include CPR?(Required)

Instructors

Registration

MM slash DD slash YYYY

Student Communication

AdventureMed to send pre-course email(Required)

Payment

Payment Method(Required)
If the payable party wants to receive payment via direct deposit, ensure a direct deposit form has been sent to AdventureMed prior to the start of the course.

If the payable party wants to receive payment via a mailed check, ensure that address is confirmed prior to the start of the course.