APPLICATION FOR

EMERGENCY MEDICAL TECHNICIAN – BASIC

NAME:                                                       

ADDRESS:                                                 

TELEPHONE:                                            

EMAIL:                                                      

DEPARTMENT AFFILIATION:                                                            

Class to be held Tuesday & Thursdays from 6pm-10pm with one Sunday/month at Summit Baptist Church on Victory Highway just north of Rte 117.  Class begins July 1^st.

Cost of class is $700.00 including text book.  Payment is due on or before the first day of class.  Checks should be made out to ABC Emergency Training and can be mailed to 102 Wisteria Drive, Coventry RI  02816.

Fax this application to:

Attn:  Captain Kelly Guastini

401-397-1084