Intro to Hyperbaric Medicine Registration for Potential Instructors

Name*

First Last

Phone*

Email*

Address*

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

Which dates are you planning to attend?*

May 19-22, 2021
June 2-5, 2021

Are you interested in obtaining ICHT Certification?

Yes
No

The path to ICHT Certification requires you to have at least one of the following pathways. Please select one:

Are you affiliated with any hyperbaric organizations? If yes, please list.

Do you plan to attend the course in person or virtually?*

In Person
Virtual

If attending virtually, do you have a computer with a camera for class participation and attendance monitoring?

Yes
No

Participation in this course must be monitored for proper credit to be given. If you do not have a camera on one of your devices, please consider acquiring one prior to attending this course.

Name and credentials you would like included on any certificates.*

Comments or questions?

Legal Acknowledgement*

“I hereby certify that all the information given is true about myself.”

YES

Intro Training Course Potential Instructor Registration Fee*

Price:

You will now be redirected to PayPal to complete your payment for the course.

Intro to Hyperbaric Medicine Registration for Potential Instructors

Register Now for an Upcoming Intro to Hyperbaric Medicine Training Course (Potential Instructors)