WFR Recertification The three day WFR Recertification course is open to graduates of ALL wilderness medical training courses of 64 hours or longer with a current Wilderness First Responder certification. Successful graduates of this course will receive Wilderness First Responder, Anaphylaxis, and BLS level CPR & AED certifications. WMA WEMT graduates may also recertify the wilderness portion of their WEMT with this course.The Dates You Would Like To Attend:*January 12th - 14th 2019March 9th - 11th 2019May 11th - 13th 2019Student InformationName* First Last Email* Enter Email Confirm Email Mailing Address For Textbook (shipping via USPS)* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*How Did You Hear About Us?*Our WebsiteWMAAMGASearch EngineReferralI'm a former studentFacebookInstagramTwitterOtherEmergency ContactEmergency Contact Name* First Last Relationship*Emergency Phone*Emergency Email* Enter Email Confirm Email Personal InformationT-Shirt Size - Unisex* Extra Small Small Medium Large X Large 2X Large Height (ft)*3'4'5'6'7'Height (in)*0"1"2"3"4"5"6"7"8"9"10"11"Weight (lbs)*Age*Parent/Guardian Name* First Last Parent/Guardian Email* Medical InformationWilderness Leadership Institute (WLI) requests this information to assist staff in the management of courses and in the emergency response of medical conditions that any participant or observer may have. This information will remain protected and confidential. By requesting this information, WLI does not imply that we have the expertise to assess your physical condition or your ability to participate in this course. This determination of ability must be made by you, the participant, in concert with your physician.Please list any relevant medical or psychological conditions that you are currently managing or have had in your past (Enter 'None' if not applicable)*Note: The following list is a non-exhaustive list of conditions that may be pertinent: musculoskeletal injuries, cardio-respiratory system problems, neurologic conditions, allergies (environmental, food, etc.), blood sugar management, heat or cold injury…Please list any medications that you take on a regular or periodic basis, and the typical dosage (Enter 'None' if not applicable)*I understand and acknowledge that Wilderness Leadership Institute is not making a determination of my fitness for a course; rather, I represent to Wilderness Leadership Institute and verify that I am physically fit and ready for the course. I have read and agree to the terms of the "Consent to Treat & Full Disclosure Statement" and the "Cancellation & Refund Policy".* Confirm Download the Consent to Treat & Full Disclosure Statement and Cancellation & Refund Policy forms.Course InformationPrevious Medical Traing (Check all that apply)* None Basic CPR Basic First Aid WFA WAFA WFR EMT WEMT Paramedic Nurse Doctor Who is your current WFR certifying entity?*Wilderness Medical Associates (WMA)NOLS (WMI)SOLODesert Mountain MedicineAERIE Backcountry MedicineRemote MedicalOtherPlease enter your WFR certifying enitity*Current WFR Expiration Date* Will you be camping on-site?*Yes, I will be camping on-site.No, I have other accommodations.The cost to camp on site is $15 per person, per night. Camping fees will be collected on the first day of class. Camping is available starting the day before the course starts. Students staying on-site will have access to the classroom, full kitchen, and bathrooms with showers. There are no pets allowed on-site.Number of Nights Camping*123456789Number of People Camping*123456789Payment Options*WFR Recertification - $399.00Total $0.00 Supported Credit Cards* MasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name Billing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code You will be redirected to sign a waiver following the completion of this form. Please review and digitally sign to complete your registration. NameThis field is for validation purposes and should be left unchanged.