Pre-REGISTRATION FORM : EMT INTERMEDIATE PROGRAM

THIS PROGRAM RUNS STARTS 1ST WEEK FEB TUES AND TH NIGHTS FROM 6-10PM
PROGRAM COST IS $525 INSIDE PARKING ADDTL $25   

Name:
    Date of Birth:
E-mail Address:


Contact Phone number:  

Street address:  City:Zipcode:

Social Security- last 4 digits:  

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 with your deposit. All tuition must be paid by CASH or MONEY ORDER or BANK CHECK only. PERSONAL CHECKS ARE NOT ACCEPTED.

 

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