Host Booking FormThis form allows us to understand more about who you are and how we can best support you. What is your company's name? * Who should I contact for organizing this course? Please provide their name, email, and phone number. * Name of course contact Email of course contact * Phone number of course contact * Country (###) ### #### What is a mailing address that Mountain Med can ship gear and textbooks too? * Address 1 Address 2 City State/Province Zip/Postal Code Country What type of course do you want to run? * Medical Seminar WFA — Wilderness First Aid WAFA — Wilderness Advanced First Aid WAFA Hybrid — Wilderness Advanced First Aid with online pre-course learning WFR — Wilderness First Responder WFR Hybrid — Wilderness First Responder with online pre-course learning WFR Bridge — Wilderness First Responder for students with an active Wilderness Advanced First Aid certificate WFR Recert — Wilderness First Responder recertification for students with an active WFR certificate Hybrid WFR Recert — Wilderness First Responder recertification for students with an active WFR certificate with online pre-course learning WALS — Wilderness Advanced Life Support Would you like this course to be advertised to the public? Yes No What is your preferred date for the course to start on? * MM DD YYYY What is your second preferred date for the course to start on? * Please provide a second option in case Mountain Med isn't available for your preferred date. MM DD YYYY What is your third preferred date for the course to start on? * Please provide a third option in case Mountain Med isn't available for your first two preferred dates. MM DD YYYY How many students do you expect? * What is the address of your course location? * Address 1 Address 2 City State/Province Zip/Postal Code Country Describe your venue. Does it have sufficient space for the amount of students to sit at tables? Is the outdoor space private and away from the public? * Does your venue have a whiteboard and projector? * Have you conducted a wilderness first aid course before? If yes, is there anything specific you would like to include or modify compared to the previous session? * Do you have any access to gear or the course? (CPR mannequins, tarps, thermarest, sleeping bags, ski poles, skis, etc.) If so, please list what you have and how many. * Does your company have an ERP? Would you like this to be incorporated into scenarios? * Provide details about your company and the nature of remote work it engages in. This information will assist us in selecting the most suitable instructor for your course. * Thank you!
