On-Line Course Registration

To enroll in a course, please complete this form and press the Submit Form button at the end.

  1. Please provide your contact information:

    First Name
    Last Name
    Middle Initial
    Street Address
    City
    State/Province
    Zip/Postal Code
    Cell Phone
    Home Phone
    E-mail

  2. Which course would you like to enroll in?

    EMT-Basic Original Course
    EMT Refresher/Challenge Refresher
    Pilot EMT Refresher Core Content Course

  3. Do you belong to a recognized NYS EMS response agency?

    Yes No  [if no, please note that tuition charges will apply]


  4. If yes, enter the name of your department or agency in the space below.


  5. Are you now, or have you ever been certified as a NYS EMT or CFR?

    Yes No

     

  6. If yes, what level of certification do you (or did you) hold?

    CFR
    EMT
    Advanced EMT


  7. If yes, please enter your NYS EMT or CFR #


  8. When will (or did) your NYS certification expire?

    -- mm/dd/yy


        NOTE: You are not registered in a course until you receive email or phone confirmation.  This may take up to 10 business days.

        Trouble with this form?  Don't freak out!  Click the envelope to email us your complaint: 

 

Copyright © 2008 Saratoga County EMS Council, Inc. All rights reserved.
Revised: 07/06/11