Contact Phone number:
Street address:
City: Zipcode:
Social Security-
last 4 digits:
expiration month/year EMT card:
Service employeed/volunteered with (or
NONE) :
Comments or
questions:
This is an initial
class not a recert. Tuition includes
all books and testing fees
. 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 .
An appointment to interview and test
will be made on receipt of application.
A deposit is required to hold your seat
if you are accepted. When you press
SUBMIT this form will be sent and a
printable form will come up to be sent
in -do not enclose money. All tuition must
be paid by CASH or MONEY ORDER or BANK
CHECK OR CREDIT CARD only. PERSONAL CHECKS ARE NOT
ACCEPTED.