REGISTRATION FORM

Pre-REGISTRATION FORM : EMT CLASSES NIGHTTIME 6-10PM
November 24th 2008 start date

THIS IS A PRE-REGISTRATION ONLY. A COMPLETED APPLICATION WITH A DEPOSIT IS NECESSARY TO HOLD A PLACE FOR YOU IN THE CLASS

NIGHT CLASS RUNS MONDAY AND WEDNESDAY NIGHTS 6-10PM

Name:
Date of Birth:
E-mail Address:
Contact Phone number: Street address: City:Zipcode: Social Security- last 4 digits: Comments or questions: This is an initial class not a recert. Tuition is $495 with all books included. If you would like to reserve a program T-Shirt please note the size in the comment area. T-shirts are $15. Books are available in advance. 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.GARAGE PARKING IS AVAILABLE AT AN ADDITIONAL CHARGE. IF INTERESTED PLEASE INDICATE IN THE COMMENTS SECTION.
Action: