Course Registration - Desert Mountain Medicine

"*" indicates required fields

WFR

October 24, 2022 - October 29, 2022

Desert Mountain Medicine- Moab - Moab, UT

If you are registering for another person, please enter their information in the form fields on this page.

Hidden

Event ID

Hidden

Course Type

Hidden

Course Date

Hidden

Course Location

Attendee Information

Name*

First Last

Pronouns

Email*

*Please ensure that this is the email of the student who is taking the course.

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

if you are outside of the US, please include your country code (e.g. 61 2 9876 5432 for AUS)

Please Upload Your Supporting Documentation*

Drop files here or

Accepted file types: jpg, gif, png, pdf, jpeg, Max. file size: 5 MB, Max. files: 3.

Files can be no larger than 1MB.

Certificate Provider*

Previous Certification Expiration Date*

Other Provider Name*

How did you hear about us?

Why are you taking this course?

I am a professional and my job requires it

For personal recreational purposes

Other

Would you like to receive College Credit with your course?

WFA - 1 College Credit - $224

For WFA and WFR courses, DMM has partnered with University of Colorado, Denver to provide college credits. Read more here.

Would you like to receive College Credit with your course?

WFR - 1 College Credit - $476

For WFA and WFR courses, DMM has partnered with University of Colorado, Denver to provide college credits. Read more here.

Date of Birth*

WFR-H*

Price:

Coupon Code

Total

Hidden

Trig

Hidden

DMM-*

Credit Card*

Card Details

Cardholder Name

Name

This field is for validation purposes and should be left unchanged.