Instructor Training Registration Form

Instructor Training Registration Form

Fill out the form carefully for registration
Student Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Phone Number*

Area CodePhone Number
Course Location and Date*
Please choose one of the following:*
Size*
Have you taken an equine first aid or other medical related equine courses before?*
Are you capable of being on your feet in an often physical capacity for at least 7 hours at a time?*
Tell us about your equine experience.*
What is your plan to promote courses and grow your new business? *
What does teaching equine first aid mean to you?*
Please upload a video - 2 minutes or less - explaining why you thing you would be an asset to the Equi-Health Team.

Choose a File

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The tuition is $2999 including tax. Choose your method of payment. Your payment will not be processed unless accepted.*
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