This program includes:
To register simply fill in the form below and we will be in touch.
First Name*
Middle Initial
Last Name*
Address (including apt)*
City*
State*
Zip*
Phone number*
Email Address*
Date of Birth*
Social Security # (last 4) xxx-xx- *
Agency Name
Unit number
Agency Code
Or "Unaffiliated"
NYS EMT Number (must be 6 digits for the field)
Expiration Date
Select One EMT-BParamedic
Current NREMT Number
Select one [checkbox-929 class:checkboxstyle use_label_element exclusive "EMT-B" "Paramedic"]
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