Fall 2021, Spring 2022 EMS Squad Recertification Registration

Contact data

This form is used to register single or multiple persons who will be billed through an invoice to an EMS squad or other entity. The total invoice needs to include at least 25 sessions, but may come from several of these forms. Each form can only apply to one session per topic so multiple forms may be needed for your squad.

Question Title

* 1. Squad Leader Information

Squad Leader Name

Billing Squad name:

Squad Address

City/Town

State/Province

ZIP/Postal Code

Squad Leader Email Address

Squad Phone Number

Question Title

* 2. Who will be attending (include yourself is you are also attending)? Email addresses will be used to register students with SanfordLearn. Each person needs a separate email address to receive their specific certificates/transcript and emails with other information.

Full name and individual's email address