EMT Refresher Registration Form

Course #: R5901
Location: ECP Bay Parkway, 6715 Bay Parkway Brooklyn, NY
Date: 02/05/2019-04/18/2019 (Tuesday, Thursday)
Time: 7:00 PM - 10:00 PM

Please fill out information below:

* required field

First Name: *
Last Name: *
Address: *
Apt #:
City: *
State: *
Zip Code: *
Primary Phone Number: * (Example: 718-123-1234)
Secondary Phone Number:
E-Mail address: *
EMT Number:*
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Emergency Care Programs?


           Enter payment via E-Check, Credit Card / Debit Card or Chase QuickPay to register now.

Comments and/or additional information:
(Maximum 150 characters!)

Registration is not complete until your $195.00 non-refundable registration fee is received.



           Print and mail with your payment.