Individual Registration

Salem EMT Class Enrollment

You are enrolling in the Salem EMT Class, with lab sessions on Tuesday and Thursday evenings.

This form is set up to charge the $350 deposit. If you wish to pay in full, select "Full Payment" instead.

Please ensure you have selected the correct class before proceeding.

Existing user? Please login

New User? Please register

Username*

Password*

Retype Password*

Last Name *

First Name *

Address *

City *

Zip *

State *

Phone *

Email *

Personal email preferred as some business email systems may filter communication related to your enrollment.

Date of Birth

This is not required now but will be required later for the State final roster.

Last 4 Digits of SS#

This is not required now but will be required later for the State final roster.

Course Fee *

I understand that the balance must be paid in full by the first day of class.

Course Fee *

I understand that the course must be paid in full prior to the start of the class and the deposit is not refundable.

If you wish to utilize a payment plan, choose the Full Payment during enrollment (not Deposit Payment), select PayPal, and then choose PayPal credit while signed in to the PayPal site.

Minor Check *

I will be at least 18 at the start of the course

I will be 17 at the start of the course but will be 18 at the conclusion of the course.

Minors will require a signed parental/guardian consent form before the first day of the course. Form provided a few weeks prior to start.

Course Format *

I understand that in addition to the in-class lab sessions I will be required to complete weekly online assignments. I have reviewed the schedule on the course description page and can attend all of the in-class sessions.

Accelerated Pace *

I acknowledge the accelerated pace of this course, understanding that I will need to read 5-6 chapters per week and complete the associated online coursework. Given these requirements, this course is not recommended for individuals with limited availability to commit to the online coursework. Alternatively, a traditionally paced class will be available in September for those seeking a more conventional learning experience.

Payment Information

Coupon

Amount

Discount Amount

Gross Amount

Deposit Amount

Payment Type

Payment Method *

Credit Card Paypal

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Holder Name*

By registering for this event, I accept Terms and Conditions

Individual Registration

Salem EMT Class Enrollment

Existing user? Please login

New User? Please register

Payment Information

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