Workshop Application

Garden City Community College

October 13, 2007

Last Name:

First Name:

Address:

City:                            State:               Zip:            

Service:                                         

Attendant ID #:                                      

Level of Certification:    TO           TO2           IC        

Attendant Certification:  FR      EMT      EMT I    MICT         

Cost of the workshop is $65.00. Lunch will be on your own.  Please include Check or Money Order, Made out to SKEMS with application.  PO's must have Service Directors signature.

Registration will begin at 7:30 am

Work Shop will begin at 8:00 and end at 5:15 pm

Sign in will be required in the morning and right after lunch.

print off and send to: SKEMS  475 S Towns Blvd.  Garden City, Ks 67846