AdventureMed Partner Application - Wilderness Medicine

Check all that apply(Required)

First Name(Required)

Last Name(Required)

Company or Employer

Position/Title

Address

Work Phone

Mobile Phone

Fax

Email Address(Required)

What is your level of formal medical training?

What is the expiration date of your WLS:MP/WFR/WFA certificate (if applicable)?

Describe your experience and background in wilderness activities and skills (including search & rescue, clinics, leadership roles, activities).

Describe your teaching background and experience.

List any experience you have had in general emergency medical care.

When are you interested in starting your role as an AWLS/BWLS/WLS instructor?

Do you have a proposed location for sponsoring a course?

Are you also submitting this application with the intent of becoming a Lead instructor?

Please upload your resume here(Required)

Max. file size: 50 MB.