Northwest GA EMS D.A.R.T Course (16 hrs)
West Georgia Technical College, Waco, GA
Bremen Room
May 4th & 5th, 2017
0800-1700
Please complete and return the pre-registration form if mailing a check for additional shirts(s)to
NW GA EMS Systems Inc,
500 Riverside Parkway N.E.
Rome, GA 30161
Attn: DART Course
or email to David Foster if not ordering additional DART T Shirts @
First Name / MI / Last Name
Street Address / City / State / Zip
Agency / Title / State Level & #
Email Address / Office/Home Phone / Cell #
Registration Deadline by COB Friday April 21, 2017
This Course is Limited to 80 participants and is open to Licensed EMS Personnel who work for a Region 1 Licensed EMS Medical First Responder Agency and Hospital Personnel (Licensed Providers (EMT, RN, PA, MD, etc) who agree to deploy for Field Care in the event of a Disaster Response.