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Wilderness first aid and medical programs offered by SIRIUS may be modified to accomodate the needs of your group. If your group or organization would like to sponsor a course please fill out the form below.

Alternately, you can also download the form and fax / mail it to us at:

SIRIUS WILDERNESS MEDICINE
2685, rue Rolland, Suite 303
Sainte-Adèle, Qc, Canada, J8B 1C9
Tel: (514) 509-2112  • Fax: (514) 509-2123
 

ASCII Group Information Form
MS WORD Group Information Form

Group Information:
Organization Name:
Contact Person:
Title:
Organization Activity(ies):

Address:
Street:
City:  
Prov/State:  Postal Code:        
Country:
Phone:
Fax:  
Email:  
Web Site:

Course Information:
Course Type:
      If other, please specify
Number of persons to be certified:
Do they have any previous first aid experience? Yes     No   
     If yes, please describe:
CPR needed? Yes     No 
Proposed dates for the program
Do you have a facility to run the course? Yes     No 
Do you have any audio-visual equipment available? Yes     No 
Do you have accomodations for the instructor? Yes     No 

Comments or questions:
                         

 

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2685, rue Rolland, Suite 303
Sainte-Adèle, Qc, Canada, J8B 1C9
Tel: (514) 509-2112  • Fax: (514) 509-2123
Email: info@siriusmed.com
TOLL FREE in Canada: 1 (877) 982-0066

Copyright © 1996-2005 Sirius Wilderness Medicine