Course Request - AdventureMed - Wilderness Medicine Education

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

League(Required)

Start Date(Required)

Start Time(Required)

End Date(Required)

End Time(Required)

Location(Required)

Will this class include CPR?(Required)

Yes

Instructors

Lead(Required)

Assistant(s)

Registration

Date registration will close(Required)

Max # of participants

Registration Fee (if different than recommended $100):

Student Communication

AdventureMed to send pre-course email(Required)

Yes

Payment

Payable Party(Required)

Payment Method(Required)

Direct Deposit

Mailed Check

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.