Pre-REGISTRATION FORM : EMT BASIC recert START  MARCH 19,20, 21
Name:
E-mail Address:


Contact Phone number:  

Street address:  City:Zipcode:

Social Security- last 4 digits: 

Comments or questions:

 

This is a recert not an initial class. Tuition is $200 with all materials included. If you would like to reserve a program T-Shirt please note the size in the comment area. T-shirts are $15.  
A deposit is necessary to hold your registration.  When you press SUBMIT this form will be sent and a printable form will come up to be sent in with your deposit. All tuition must be paid by CASH or MONEY ORDER or BANK CHECK only. PERSONAL CHECKS ARE NOT ACCEPTED.

 

Action:

Submit registration