EMR Registration
First Name
Last Name
Date of Birth
Email
Phone Number
Address
I verify I have never been suspended from holding a EMS license in Illinois or any other state
I verify that I am 16 year of age or older
I verify that I have no felony convictions in the state of Illinois or any other state
What if any department are you affiliated with
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I acknowledge that the above information is true and valid. I also understand that I am responsible for the cost of the course and after the first night of class, no refunds will be given. I also understand payment is required prior to the first nigh
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