The code block below illustrates how one might use # and // as comments in your logic and calculations.

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Required format:

TFthn36LBZ7fDbYPctx3PrhIUTucGYz7y8bMK38c3m68EE8ttqqknwBojojbazgSigSfNaVCLvGHkBYd

RF-DASH Training Registration - Aztec, New Mexico

Please complete the registration form below to confirm your spot at the RF-DASH training on March 30, 2024 in Aztec, New Mexico. There are 25 spots available for this training.

A voluntary course fee of $50 is suggested but not required. We will begin accepting voluntary course fees on March 1, 2024. Voluntary fees support the RF-DASH program by partially covering training costs. Voluntary course fees can be paid by either check or credit card. To pay by credit card, please call 715-387-5760 (Marshfield Clinic accepts MasterCard, Visa, American Express, and Discover). To pay be check, please mail a check to the address below. Make checks payable to Marshfield Clinic Health System Inc.

National Farm Medicine Center
Conference Registration
1000 North Oak Avenue, ML-8
Marshfield, WI 54449

If you have any questions, please contact rfdash@marshfieldresearch.org or call Jakob Hanschu at 715-389-4141.

Thank you!

Name (First and Last):

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Address:

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City:

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State:

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Zip Code:

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Phone (Daytime):

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Email Address:

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Which of the following best describes your occupation? You may select more than one.

Firefighter

EMS

Law Enforcement

Farmer

Other

Please describe:

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Department/agency you are representing:

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How many years have you been a firefighter and/or EMS?

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How many years have you been in law enforcement?

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List your level of fire/EMS training:

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Are you paid or volunteer?

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Paid

Volunteer

Combination paid/volunteer

Other:

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Please describe:

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Have you or your department ever responded to a farm emergency?

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Yes

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How many farm emergencies have you or your department responded to in the last year?

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How well do you understand farms and farm operations?

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Change the slider above to set a response

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How prepared is your department for a farm emergency?

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Change the slider above to set a response

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Have you ever had an injury or other emergency situation on your farm?

Yes

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Please briefly describe the injury/emergency event:

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How prepared do you think your local emergency services are to respond to an emergency event on your farm?

Change the slider above to set a response

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How confident are you in your ability to accurately assess farm hazards?

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Change the slider above to set a response

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Were you previously trained in RF-DASH?

* must provide value

Yes

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