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Pediatric Pitfalls Registration
Thank you for your interest in the Pediatric Pitfalls program being offered in person on March 28, 2026, 9 AM to 5 PM.
Please complete the following survey to register for this in-person class.
*
1.
First Name
(Required.)
*
2.
Last Name
(Required.)
3.
Organization/Agency Affiliation Name
4.
Organization/Agency Affiliation County
5.
Phone Number
*
6.
Email Address
(Required.)
*
7.
Date of Birth
(Required.)
8.
PA EMS Certification Number (if applicable)
9.
PA EMS Certification Level (if applicable)
Emergency Medical Responder (EMR)
Emergency Medical Technician (EMT)
Advanced Emergency Medical Technician (AEMT)
Paramedic
Pre-Hospital Registered Nurse (PHRN)
Pre-Hospital Physician Extender (PHPE)
Pre-Hospital Physician (PHP)
