BASE MEDICAL
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Base Medical Certified Education Center Application
Organization Information
*
Indicates required field
Organization Name
*
Location of Organization
*
Website Address
*
Organization Member Size
*
Description of Organization
*
Type
*
For Profit
Non-profit
Other
Please list your current wilderness medicine education provider if you have one.
*
Contact Information
Point of Contact Name
*
First
Last
[object Object]
Position
*
Email
*
Phone
*
Instructor Candidates
One of the requirements to become a Base Medical Certified Organization is to certify a member or several members from your organization as an instructor.
Do you have individuals selected as potential instructor candidates?
*
Yes
No
Maybe
How many potential instructor candidates?
*
0-1
2-5
5-10
10+
What is the general experience of the instructor candidates?
*
No wilderness medicine education experience
Some wilderness medicine education experience
Very experienced in wilderness medicine education
When do you hope to offer your first wilderness medicine course?
*
How do you plan to use our program?
*
How did you hear about Base Medical?
*
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100% Online Recert
Remote Training
About
About Base Medical
Jobs
Program Standards
>
Scope Of Education
Curriculum Authors
Prodeal
Partners & Affiliates
Our Team
Contact
LOG IN
Student Log In
Team Log IN