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Paramedic Refresher Registration Form

Paramedic 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)

First
Last
If you are not an IN resident please put 'N/A' in this field.
Gender