This is the registration form for the EZ-IO Train-the-Trainer classes be offered by Tidewater EMS Council. These classes are primarily for the instructors for the jurisdictions in the region, but if space allows, any provider may attend. The attendees of these class will be expected to assist in the training of the ALS field providers throughout the region to prepare for the deployment of the EZ-IO devices later this summer.

Classes will be held at Tidewater EMS in the Weber Sim Center in Norfolk on the following dates:

Thursday May 29th @ 1800
Saturday May 31st @ 1000
Tuesday June 3rd @ 1300 

EZ-IO Train-the-Trainer

Registration form

I would like to sign up for the:
  

Title:                                         

First Name:                           

Last Name:                           

Street Address:                   

Other Address:                   

City:                                           State:        Zip Code:   

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Primary Email:                     

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Contact Phone Number:           (Please enter in (###) ###-#### format.)