CTAA PASS Wheelchair Securement & NEMTAC Stretcher Driver Training Registration Form

CTAA/NEMTACTraining Registration Form

Enter your details and submit the information needed for training wheelchair and/or stretcher training.
Transportation Company Name
Company Address
If signing up more than "15" drivers at the same time, would you prefer the class to take place at your company’s office?
Location Requirement:
I confirm that our company has the available resources (check all that apply):
Driver's Name

First NameLast Name
I confirm that our company has the available resources (select all that apply):
File Upload

Please attach an excel sheet with all drivers first and last name as well as unique email address, that will be attending training, at your location.
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Owner/Manager's Name

First NameLast Name
Driver's Unique Email Address
Owner/Manager's Unique Email Address
Driver's Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Owner/Managers Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Which training are you registering for?
Is this:
Do you have prior experience with wheelchair or stretcher handling?
Preffered Training Site:
Is a wheelchair vehicle able to be provided for the duration of the classs?
You will need to complete registration once you have confirmed that you can provide a wheelchair-accessible vehicle for the training session you plan to attend.

If multiple drivers from the same company are registering for the same training date, only one wheelchair-accessible vehicle is required. The driver assigned to provide the vehicle should select "Yes", and all other drivers from that company may also select "Yes" during registration, as the vehicle requirement has already been met by their company.
Individual emails are required for every driver.

The email that is entered will be where the CTAA On-Demand training will be sent to as well as the certificate of completion. The On-Demand training will have to be completed and certificate issued before attending the hands-on training. The On-Demand training runs around 4-6 hours.

Select the training date you would like to attend. Then scroll down to view the training location. Please select only one date and location.

This is a one-day class held from 9:00 AM to 2:30 PM EST, with a scheduled break and a lunch period.

Do you need to sign up more than 15 drivers? Don't select a class date. After you register, we'll contact your organization to schedule a training date, time, and location that works best for your team. Please add a note at the end of this form to alert us of this need.
Training Dates
Please share any specific needs or comments regarding your training.
Signature
Should be Empty:

CTAA/NEMTACTraining Registration Form