Summer Training Institute 2017 - Registration and Payment Information


To register online, please fill out the form below and click the "Submit" button.

Register by Mail

To register by mail, please print out the form below and send it with a check payable to The Trauma Center at JRI, for the appropriate fee. Registration will be confirmed when payment is received. Please CIRCLE the item(s) you are registering for. Space is limited, and registration will be on a first come, first served basis.

1-, 2-, and 3-Day Option

If you are attending a 1-, 2-, and 3-Day option, please specify the days you will be attending and the program for which you are registering.

Please note that Trauma Drama is completely SOLD OUT! If you are registering for a 4- or 5-Day option, you must choose Track B (Skills System) for Thursday.

Registration Form

Personal Information:

License Number:
Email Address:
Work Phone:
Home/Cell/Other Phone:
Employer if "Group":
Street Address:
City, State, Zip Code
International (if not USA)
Which days are you registering for? Mon-Fri; Mon-Thu; Tue-Fri
Which track are you registering for Days 2 & 3? A = ARC; B = TCTSY & CBP
Which track are you registering for Day 4? A = TD; B = SS

If you do not receive a "thank you" email after submitting your form, please email the Training Division administrative support staff, for confirmation.