EMT Refresher Registration Form

Upon receipt of your registration form, Pelham Training will reach out to you via e-mail to the e-mail address you have listed on your registration form, to confirm registration.
Depending on how you have your e-mail inbox configured, this important email may go to your junk mail folder. If you have not received a response within 2 business days of transmitting your application to us, please check your junk mail folder. If after doing so you still have not received a response, please contact us..
Methods of Payment: The balance is due on or prior to the first day of class. We accept cash, check or card.

Student Information (All Fields Required)

Name *

First

Last Name *

Last

Address *

City *

State *

Zip Code *

County *

Cell Phone *

Email *

Age *

Date of Birth *

EMT REFRESHER DATES *

Additional Information, Questions or Concerns

If you are human, leave this field blank.