DONATE Consider making a recurring tax-deductible donation. Know, that through your support, you are among those whose vision and passion will keep the paramedic role in critical care transport vibrant now and for generations to come. Also consider the THF in your estate planning! Recurring Payment Authorization Form I ____________________________ authorize The Tim Hynes Foundation to charge my credit card indicated below for $_____ each month as a tax-deductible donation to support THF activities. Billing Address Phone# City, State, Zip Email Visa MasterCard Amex Cardholder Name Account Number Exp. Date SIGNATURE DATE I understand that this authorization will remain in effect until I cancel it in writing at least 15 days prior to the next billing date. I certify that I am an authorized user of this credit card account and will not dispute these scheduled transactions with my bank or credit card company; so long as the transactions correspond to the terms indicated in this authorization form. Tim Hynes Foundation 4835 Riveredge Cove • Snellville, GA 30039 770-979-6372 • www.timhynesfoundation.org Safety Management Training Academy SCHOLARSHIP PROGRAM
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SMTA ScholarshipBroch 2017 - cdn.ymaws.com · Trainer Certificate • OSHA Training and ‘wallet card’ verifying completion of course content taught by OSHA authorized instructors
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DONATE
Consider making a recurring tax-deductible donation. Know, thatthroughyoursupport,youareamongthosewhosevisionandpassionwillkeeptheparamedicroleincriticalcaretransportvibrantnowandfor generations to come. Also consider the THF in your estateplanning!
RecurringPaymentAuthorizationFormI ____________________________ authorize The Tim HynesFoundationtochargemycreditcardindicatedbelowfor$_____each month as a tax-deductible donation to support THFactivities.BillingAddress Phone# City,State,Zip Email
�Visa �MasterCard�AmexCardholderName AccountNumber Exp.Date SIGNATURE DATE IunderstandthatthisauthorizationwillremainineffectuntilIcancelitinwritingatleast15dayspriortothenextbillingdate.IcertifythatIamanauthorizeduserofthiscreditcardaccountandwillnotdispute thesescheduled transactionswithmy bank orcreditcard company; so long as the transactions correspond to the terms indicated in thisauthorizationform.
Tim Hynes Foundation 4835 Riveredge Cove • Snellville, GA 30039
770-979-6372 • www.timhynesfoundation.org
Safety Management
Training Academy SCHOLARSHIP PROGRAM
Submission deadline: Dec. 31, 2016 Recipient will be announced at CCTMC in April Questions? Contact John Clark at 678.368.4970
WhatisSMTA? ScholarshipEligibility
Safety Management Training Academy (SMTA) is a robusttrainingprogramonsafetymanagementfortheairmedicaland critical care community. The program provides acomprehensivefoundationin thescienceandapplicationofthe discipline of safety systems for current and futureleadersinemergencymedicaltransport.
ScholarshipTermsThe THF will provide the scholarship funding directly to theSMTA training facility, in the amount of a double roompackage. This package includes five nights lodging, breakfastand lunch Monday through Thursday, Sunday eveningreception/dinner,ThursdayeveningGraduationBanquet,andacontinental go-tobreakfastonFridaymorning. Also includedin the scholarship amount is the cost of all classes,monographs,studymaterialsandcoffeebreaks.