Emergency Medical Training, Inc.

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Please fill in all information as completely as possible. Once registration form is received, a verification email will be sent to the email address provided. If there is no email address then a member of the office staff will contact you by phone to confirm your registration into the class requested.

It is very important that the information provided be as accurate as possible, especially in the event of a class cancellation or if a class reaches maximum capacity.

Although a registration form will be on hand, and a confirmation notification received back to the student, the only way a position in the class can be held in cases of maximum capacity is the required 20% down payment having arrived in our office at least 2 weeks in advance.

**This down payment must be received prior to ordering any class materials for the students also 2 weeks prior to the first class.**

*Note- There will be a 20% handling charge (of check face value) for all returned checks.*

We accept PayPal for your convenience.

Name [First/Last] *
Address *
City/Town *
State/Province *
Zip Code *
Home Phone *
Work Phone *
E-mail *
Class Requested *	Please choose your selection here
Type RIEMT Basic License number here if you are signing up for a RIEMT Cardiac class.
Select any of the following options that apply *	Money Order PayPal Invioice Employer Dept. PO Personal Check
Yes, I have read the disclaimer page on this website. *	Yes No
Yes, I understand that the deposit or full payment is required to hold my spot and ordering of all books. *	Yes No

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