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.