NYS EMS Course Registration

* Denotes Required Field

*Required
*Last-Name:
*First-Name:
*Address:
*City:
*State:
*Zip:
County:
*Phone:
*E-Mail:
*Date of Birth:

NYS ID Number (if applicable):

Name of Primary EMS Agency:

Who will be paying the course tuition costs?

Select from the following courses:






Price:
*Passcode:
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Registration is not complete until you pay.