NYS CME Participant - Registration Form 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 How did you hear about us?