REGISTRATION
*This form is to be filled out if you are fully ready to register for a course. If you are looking for further information or have a question, please use the ‘Contact Us’ form.

Pelham Training Course 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 and to set up a time to call in your down payment.
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..

All students attending EMT class must apply for a PSID # from the Indiana Department of Homeland Security. You MUST have your PSID # prior to the beginning of class. Students attending EMT class from places outside Indiana are still required to have a PSID # prior to the beginning of class. There are no exceptions.
Complete information on how to apply for your PSID # will be included in your Welcome Packet that you will receive after your down payment has been placed.

Methods of Payment: A down payment to hold your seat is required, payable by phone. The remaining balance is due on or prior to the first day of class. Paramedic payment schedules will be included in your acceptance letter.

Student Information (All Fields Required)

First and Last Name *

First

Last Name *

Last

Address *

City *

State *

Zip Code *

County *

Driver's License Number *

Age *

Date of Birth *

Shirt Size * Please select one... Small Medium Large X-Large 2X-Large 3X-Large

Cell Phone *

Email *

Which Course are you interested/Registering in? *

17-Day EMT Academy

Paramedic Program

EMT Practical Exam

Paramedic Practical Exam

Paramedic Refresher Week

Critical Care Course

Trauma Lanes

ACLS

ACLS Refresher

Law Enforcement Tactical Trauma

OtherOther

Preferred Method of contact *

Email

Phone

Additional Information, Questions or Concerns

Submit

If you are human, leave this field blank.

 Phone registration hours are Monday – Friday from 9 a.m. to 4 p.m. at 812.381.9001