RWJUH EMS & Trauma Education Offsite Course Request Form

EMS & Trauma Education

Request a Course at your Location

Many of our courses are available to be customized to your organization or business needs. Some courses do have a minimum or maximum number of participants that can be accomodated and others have special space needs. Please fill out the form below to help one of our educators evaluate our ability to meet your training needs.

Contact Information:

Name:

Organization:

Address:

City:

State:

Zip Code:

Daytime Phone:

Extension:

Best time to call:

9am-12pm

12pm-5pm

3pm-11pm

E-mail address:

Course Information:

Course Type:

Please supply any additional information about the type of course or your requirements:

When are you looking to hold a course:

1 to 2 months

2 to 4 months

4 to 6 months

Information about the teaching area:

Is the room:

Large
25+ people

Medium
12-24 people

Small
6-12 people

What is on the floor?

Hard surface

Carpet

Audio/Visual Equipment available on site:

TV/VCR

DVD

Slide Projector

Projection Screen

Computer

Computer Projector

Other Equipment:

This information will be sent via e-mail to ems@rwjuh.edu.

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