First Name *

Last Name *

Email *

Phone *

Address 1 *

Address 2

City *

State/Province *
- Select State Alabama Alaska American Samoa Arizona Arkansas Armed Forces Afr/Can/EU/ME Armed Forces Americas Armed Forces Pacific Baker Island California Colorado Connecticut Delaware Federated State of Micronesia Florida Georgia Guam Hawaii Howland Island Idaho Illinois Indiana Iowa Johnston Atoll Kansas Kentucky Kingman Reef Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Midway Islands Minnesota Mississippi Missouri Montana Navassa Island Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Palmyra Atoll Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Trust Territory of Pacific Utah Vermont Virgin Islands Virginia Wake Island Washington Washington D.C. West Virginia Wisconsin Wyoming

Zip/Postal *

Course Selection *
- Select Option Full Course Recertification (2 available)

Full course payment option *
- Select Option GVSU Student ($575.00) GVSU Faculty, Staff, & Alumni ($650.00) General Public ($700.00)

Recertification payment options *
- Select Option General Public ($385.00) GVSU Faculty/ Staff/ Alumni ($360.00) GVSU Student ($330.00)

Highest level of medical training Received?
- Select Option None CPR/ First Aid & AED Wilderness First Aid (WFA) Wilderness First Responder (WFR) Wilderness EMT ( WEMT) EMT Not listed Please specify a value for Highest level of medical training Received?

LODGING

On-campus lodging is optional but if you need accommodations, please complete the section below to reserve a room. Choices include a single occupancy room or shared room with 1 other participant.

Are you interested in on-campus housing? *
- Select Option Yes No

Check-In Date
- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 - 2025

Select the number of nights staying
- Select Option 2 Nights 3 Nights 4 Nights 5 Nights 6 Nights 7 Nights

Make a Selection *
- Select Option 2-Night Shared Room ($36.00) 2-Night Single Occupancy Room ($72.00)

Make a Selection *
- Select Option 3-Night Shared Room ($54.00) 3-Night Single Occupancy Room ($108.00)

Make a Selection *
- Select Option 4-Night Shared Room ($72.00) 4-Night Single Occupancy Room ($144.00)

Make a Selection *
- Select Option 5-Night Shared Room ($90.00) 5-Night Single Occupancy Room ($180.00)

Make a Selection *
- Select Option 6-Night Shared Room ($108.00) 6-Night Single Occupancy Room ($216.00)

Make a Selection *
- Select Option 7-Night Shared Room ($126.00) 7-Night Single Occupancy Room ($252.00)

If you selected a SHARED room option, please tell us about your roommate preferences (e.g. man/ woman or specific participant) *

On-campus housing does NOT include linens (sheets, pillow case, etc). Participants are required to provide their own bedding. *
I understand

EMERGENCY CONTACT INFORMATION

Name *

Phone Number *

Relation to participant *

First Name *

Last Name *

Email *

Phone *

Address 1 *

Address 2

City *

State/Province *
- Select State Alabama Alaska American Samoa Arizona Arkansas Armed Forces Afr/Can/EU/ME Armed Forces Americas Armed Forces Pacific Baker Island California Colorado Connecticut Delaware Federated State of Micronesia Florida Georgia Guam Hawaii Howland Island Idaho Illinois Indiana Iowa Johnston Atoll Kansas Kentucky Kingman Reef Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Midway Islands Minnesota Mississippi Missouri Montana Navassa Island Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Palmyra Atoll Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Trust Territory of Pacific Utah Vermont Virgin Islands Virginia Wake Island Washington Washington D.C. West Virginia Wisconsin Wyoming

Zip/Postal *

Course Selection *
- Select Option Full Course Recertification (2 available)

Full course payment option *
- Select Option GVSU Student ($575.00) GVSU Faculty, Staff, & Alumni ($650.00) General Public ($700.00)

Recertification payment options *
- Select Option General Public ($385.00) GVSU Faculty/ Staff/ Alumni ($360.00) GVSU Student ($330.00)

Highest level of medical training Received?
- Select Option None CPR/ First Aid & AED Wilderness First Aid (WFA) Wilderness First Responder (WFR) Wilderness EMT ( WEMT) EMT Not listed Please specify a value for Highest level of medical training Received?

LODGING

On-campus lodging is optional but if you need accommodations, please complete the section below to reserve a room. Choices include a single occupancy room or shared room with 1 other participant.

Are you interested in on-campus housing? *
- Select Option Yes No

Check-In Date
- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 - 2025

Select the number of nights staying
- Select Option 2 Nights 3 Nights 4 Nights 5 Nights 6 Nights 7 Nights

Make a Selection *
- Select Option 2-Night Shared Room ($36.00) 2-Night Single Occupancy Room ($72.00)

Make a Selection *
- Select Option 3-Night Shared Room ($54.00) 3-Night Single Occupancy Room ($108.00)

Make a Selection *
- Select Option 4-Night Shared Room ($72.00) 4-Night Single Occupancy Room ($144.00)

Make a Selection *
- Select Option 5-Night Shared Room ($90.00) 5-Night Single Occupancy Room ($180.00)

Make a Selection *
- Select Option 6-Night Shared Room ($108.00) 6-Night Single Occupancy Room ($216.00)

Make a Selection *
- Select Option 7-Night Shared Room ($126.00) 7-Night Single Occupancy Room ($252.00)

If you selected a SHARED room option, please tell us about your roommate preferences (e.g. man/ woman or specific participant) *

On-campus housing does NOT include linens (sheets, pillow case, etc). Participants are required to provide their own bedding. *
I understand

EMERGENCY CONTACT INFORMATION

Name *

Phone Number *

Relation to participant *

First Name *

Last Name *

Email *

Phone *

Address 1 *

Address 2

City *

State/Province *
- Select State Alabama Alaska American Samoa Arizona Arkansas Armed Forces Afr/Can/EU/ME Armed Forces Americas Armed Forces Pacific Baker Island California Colorado Connecticut Delaware Federated State of Micronesia Florida Georgia Guam Hawaii Howland Island Idaho Illinois Indiana Iowa Johnston Atoll Kansas Kentucky Kingman Reef Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Midway Islands Minnesota Mississippi Missouri Montana Navassa Island Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Palmyra Atoll Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Trust Territory of Pacific Utah Vermont Virgin Islands Virginia Wake Island Washington Washington D.C. West Virginia Wisconsin Wyoming

Zip/Postal *

Course Selection *
- Select Option Full Course Recertification (2 available)

Full course payment option *
- Select Option GVSU Student ($575.00) GVSU Faculty, Staff, & Alumni ($650.00) General Public ($700.00)

Recertification payment options *
- Select Option General Public ($385.00) GVSU Faculty/ Staff/ Alumni ($360.00) GVSU Student ($330.00)

Highest level of medical training Received?
- Select Option None CPR/ First Aid & AED Wilderness First Aid (WFA) Wilderness First Responder (WFR) Wilderness EMT ( WEMT) EMT Not listed Please specify a value for Highest level of medical training Received?

LODGING

On-campus lodging is optional but if you need accommodations, please complete the section below to reserve a room. Choices include a single occupancy room or shared room with 1 other participant.

Are you interested in on-campus housing? *
- Select Option Yes No

Check-In Date
- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 - 2025

Select the number of nights staying
- Select Option 2 Nights 3 Nights 4 Nights 5 Nights 6 Nights 7 Nights

Make a Selection *
- Select Option 2-Night Shared Room ($36.00) 2-Night Single Occupancy Room ($72.00)

Make a Selection *
- Select Option 3-Night Shared Room ($54.00) 3-Night Single Occupancy Room ($108.00)

Make a Selection *
- Select Option 4-Night Shared Room ($72.00) 4-Night Single Occupancy Room ($144.00)

Make a Selection *
- Select Option 5-Night Shared Room ($90.00) 5-Night Single Occupancy Room ($180.00)

Make a Selection *
- Select Option 6-Night Shared Room ($108.00) 6-Night Single Occupancy Room ($216.00)

Make a Selection *
- Select Option 7-Night Shared Room ($126.00) 7-Night Single Occupancy Room ($252.00)

If you selected a SHARED room option, please tell us about your roommate preferences (e.g. man/ woman or specific participant) *

On-campus housing does NOT include linens (sheets, pillow case, etc). Participants are required to provide their own bedding. *
I understand

EMERGENCY CONTACT INFORMATION

Name *

Phone Number *

Relation to participant *