Aerie Backcountry Medicine

This online registration form allows you to register and pay for your class in one easy step. The down payment for this course is required to complete registration (payment information will be collected at the end of the form).

If you would prefer to mail in a registration form, you can download the Registration Form (PDF).

All fields are required unless otherwise noted.

Course Information:

Semester

Montana

Jun 13, 2021 - Aug 14, 2021

$15,000.00

Course Details:

Thank you for your interest in our Summer Semester. We are still accepting applications for Summer 2021!

Click here to be directed to the Montana Semester information page, which includes costs, dates, and certifications.

Your Contact Information:

First Name (as it should appear on your certification)

Last Name (as it should appear on your certification)

Email Address

Confirm Email Address

Address (currently valid)

City

State

ZIP (5-digit)

Phone

Alternate Phone (optional)

Emergency Contact:

Emergency Contact Name

Emergency Contact Phone

Emergency Contact Relation

Your Background Information:

Previous First Aid Training

How did you hear about Aerie/this course?

Please add any comments about how/where you heard about Aerie (optional)

What are your outdoor interests/reasons for taking this course? (optional)

Billing Information:

First Name on Card

Last Name on Card

Payment Amount Enter a number only (no dollar sign).
You can pay either an initial down payment (minimum $2,000.00) or the full course cost ($15,000.00).

Credit Card Number Enter a number only (no spaces or dashes).

Expiration Date

Month

Year

Security Number This number can be found on the back of your card.

Billing Address

Address

City

State

ZIP (5-digit)

Please read and review Aerie Backcountry Medicine's School Policies before registering for this course. You will be required to sign this document, in person, on the first day of class. Aerie will provide printed copies in class.

Aerie Backcountry Medicine School Policies

Download our PDF textbook for free before your course begins! You can find it here: https://aeriemedicine.com/textbook

I have read and fully understand the course refund and cancellation policies. I understand Aerie courses may be physically demanding. I know of no medical conditions that prevent me from taking this course.

If you have any questions about the requirements or risks involved with this course, please contact us.

Please review all of your information before submitting your registration.
Your credit card will be charged as soon as your registration is successfully submitted.

Note: Aerie will send system-generated emails from info@aeriemed.com. These emails contain valuable and necessary course information. To ensure proper delivery, please check your spam/junk folders and mark info@aeriemed.com as an approved contact.