Organization or Emergency Squad Affiliated with:
WV Certification #
For each additional participate, please have them register separate to ensure they receive credit.
By clicking "I Agree" below you agree to and understand the following terms: -I understand that this form serves as an electronic signature verifying my participation in session on the date listed above. -I understand that teleECHO sessions may be recorded and I consent to being recorded. - I understand that I must adhere to HIPPA guidelines. I also agree to sign up for text message reminders of the upcoming ECHO and possible surveys or data collection.
I do not agree