BTOMS Registration - Knuckle Dragger Training

Name *

First

Last

Date of Birth *

Gender *

Email *

Cell Phone *

Home Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Certification Level *

State Certification Number

National Certification Number

Certification Expiration Date

Agency Address

Address Line 1

Address Line 2

City

State

Zip Code

Travel Information *

Flying (We only pickup from IAH – Bush Intercont.)
Driving

Flight Information (If unknown please email as soon as possible))

Carrier, Flight Number, Arrival Date/Time (ex. AA1027 05-06-23 @ 0940)

Additional People From Your Agency Attending

List Any Food or Drug Allergies *

Course Tuition and Fees

In an attempt to make the course as all-inclusive as possible, tuition covers all course material, NAEMT Certification, meals (breakfast, lunch, and dinner), travel to and from the training venues, and all required training equipment.

Tuition with Lodging

This includes lodging at the Host Hotel. Students who choose this option will be in a double room. Roommates are based on travel companions, course team assignments, and gender. You can choose to be solo in a room for an additional fee. – $ 2,600.00

Tuition with Lodging (Solo Occupancy)

This includes lodging at the Host Hotel. Students who choose this option will not have a roommate. – $ 2,900.00

Tuition without Lodging (Local)

Students who choose this option will NOT have a room reserved at the Host Hotel. This is for students who plan on securing their own hotel reservations or live local. – $ 2,000.00

Total

$ 0.00

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